Mario Downs

A Systematic Community-Based Participatory Approach to Refining an Evidence-Based Community-Level Intervention The HOLA Intervention for Latino Men Who Have Sex With Men

Our community-based participatory research partnership engaged in a multistep process to refine a culturally congruent intervention that builds on existing community strengths to promote sexual health among immigrant Latino men who have sex with men (MSM). The steps were the following: (1) increase Latino MSM participation in the existing partnership, (2) establish an Intervention Team, (3) review the existing sexual health literature, (4) explore needs and priorities of Latino MSM, (5) narrow priorities based on what is important and changeable, (6) blend health behavior theory with Latino MSM’s lived experiences, (7) design an intervention conceptual model, (8) develop training modules and (9) resource materials, and (10) pretest and (11) revise the intervention. The developed intervention contains four modules to train Latino MSM to serve as lay health advisors known as Navegantes. These modules synthesize locally collected data with other local and national data; blend health behavior theory, the lived experiences, and cultural values of immigrant Latino MSM; and harness the informal social support Latino MSM provide one another. This community-level intervention is designed to meet the expressed sexual health priorities of Latino MSM. It frames disease prevention within sexual health promotion.

Depressive Symptoms Among Immigrant Latino Sexual Minorities

OBJECTIVE To estimate the prevalence and identify correlates of depressive symptoms among immigrant Latino sexual minorities. METHODS Respondent-driven sampling (RDS) was used to estimate the prevalence of depressive symptoms, and univariate and multivariable analyses were conducted to identify correlates of depressive symptoms. RESULTS Unweighted and RDS-weighted prevalence estimates of depressive symptoms were 69.2% and 74.8%, respectively. In the multivariable analysis, low social support, sexual compulsivity, and high self-esteem were significantly associated with increased depressive symptoms. CONCLUSIONS A need exists for culturally congruent mental health services for immigrant Latino sexual minorities in the southern United States.

A Snapshot of How Latino Heterosexual Men Promote Sexual Health Within Their Social Networks: Process Evaluation Findings from an Efficacious Community-Level Intervention

Hombres Manteniendo Bienestar y Relaciones Saludables (HoMBReS) was a community-level social network intervention designed to increase sexual health among Latino heterosexual men who were members of a multicounty soccer league. Process data were collected each month during 18 months of intervention implementation from each of 15 trained Latino male lay health advisors (known as Navegantes) to explore the activities that Navegantes conducted to increase condom and HIV testing among their social network members. The Navegantes reported conducting 2,364 activities, for a mean of 8.8 activities per Navegante per month. The most common activity was condom distribution. Most activities were conducted with men; about 2% were conducted with women. Among activities conducted with men, half were conducted with soccer teammates and half with nonteammates. Results suggest that Latino mens social networks can be leveraged to promote sexual health within the community. Innovative methods that reach large numbers of community members are needed given the lack of prevention resources for populations disproportionately impacted by HIV and STDs.

Predictors of Heavy Episodic Drinking and Weekly Drunkenness Among Immigrant Latinos in North Carolina.

Few studies have examined correlates of heavy drinking among rural immigrant Latino men. This analysis identified correlates of typical week drunkenness and past 30-day heavy episodic drinking, within a sample of immigrant Latino men in rural North Carolina (n = 258). In the bivariate analyses, Mexican birth, entering the United States as an adult, and year-round employment were associated with increased odds of typical week drunkenness, and higher acculturation and affiliation with a religion with strict prohibitions against drinking alcohol were associated with lower odds of typical week drunkenness. Being older, Mexican birth, entering the United States as an adult, and lower acculturation were associated with increased odds of heavy episodic drinking, and affiliation with a religion with strict prohibitions against drinking alcohol and completing high school were associated with decreased odds of heavy episodic drinking. In multivariable modeling, only religious affiliation was associated with typical week drunkenness. Mexican birth, entering the United States as an adult, and lower acculturation were associated with increased odds of heavy episodic drinking, and affiliation with a religion with strict prohibitions against drinking alcohol and completing high school were associated with lower odds of heavy episodic drinking. The health of minority men in the United States has been neglected, and immigrant Latino men comprise a particularly vulnerable population. This analysis provides initial data on some factors associated with heavy drinking within a population about which little is known. Future studies should examine moderating or mediating factors between age, acculturation, religiosity, and heavy drinking that might be targets for behavioral interventions.

NOVEL APPROACHES TO HIV PREVENTION AND SEXUAL HEALTH PROMOTION AMONG GUATEMALAN GAY AND BISEXUAL MEN, MSM, AND TRANSGENDER PERSONS

The burden of HIV is disproportionate for Guatemalan sexual minorities (e.g., gay and bisexual men, men who have sex with men [MSM], and transgender persons). Our bi-national partnership used authentic approaches to community-based participatory research (CBPR) to identify characteristics of potentially successful programs to prevent HIV and promote sexual health among Guatemalan sexual minorities. Our partnership conducted Spanish-language focus groups with 87 participants who self-identified as male (n=64) or transgender (n=23) and individual in-depth interviews with ten formal and informal gay community leaders. Using constant comparison, an approach to grounded theory, we identified 20 characteristics of potentially successful programs to reduce HIV risk, including providing guidance on accessing limited resources; offering supportive dialogue around issues of masculinity, socio-cultural expectations, love, and intimacy; using Mayan values and images; harnessing technology; increasing leadership and advocacy skills; and mobilizing social networks. More research is clearly needed, but participants reported needing and wanting programming and had innovative ideas to prevent HIV exposure and transmission.

Adaptation and Implementation of HoMBReS: A Community-Level, Evidence-Based HIV Behavioral Intervention for Heterosexual Latino Men in the Midwestern United States

Over the past decade, the midwestern United States has witnessed a dramatic increase in its Latino population. The lack of culturally and linguistically congruent resources coupled with high incidence and prevalence rates of HIV among Latinos living in the Midwest merits attention. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables (Men Maintaining Wellbeing and Healthy Relationships) is a community-level social network intervention designed for Latino men. We describe the adaptation and implementation of HoMBReS for Latino men living in Indianapolis, Indiana, the second largest city in the Midwest. Five Navegantes (lay health educators) were trained; they provided a total of 34 educational charlas (small group didactic sessions). A total of 270 Latino men attended the charlas and were offered no-cost screening for HIV and sexually transmitted infections (STI). Three participants tested HIV positive and 15 screened positive for STI. The charlas coupled with the testing initiative, served as a successful method to increase sexual health knowledge among Latino men and to link newly-diagnosed HIV/STI-positive individuals to treatment and care. The adaptation and implementation of HoMBReS respond to the CDC and NIH call to increase HIV testing and service provision among vulnerable populations.

CBPR to Prevent HIV within Racial/Ethnic, Sexual, and Gender Minority Communities: Successes with Long-Term Sustainability

HIV disproportionately affects racial/ethnic, sexual, and gender minority and economically disadvantaged communities. Our community-based participatory research (CBPR) approach to HIV prevention has more than a decade-long history of sustained success. Our CBPR partnership comprises scientists and lay-experts from academic, government, and nongovernment institutions, including community-based organizations and businesses, and the community at large. We focus on developing, implementing, and evaluating prevention interventions to reduce HIV and sexually transmitted infections and increase access to health services among immigrant Latinos, including Latino men and women; and African-American/black, Latino, and white gay and bisexual men, men who have sex with men, and transgender persons. In this chapter, we identify and describe our partnership’s underlying values; predisposing, enabling, and reinforcing factors that influence and sustain our approach to CBPR; and our own real-world challenges to engagement, partnership, and CBPR.

Social support among immigrant Latino men: a validation study.

OBJECTIVE To explore the factor structure of the Index of Sojourners Social Support (ISSS) within a sample of Spanish-speaking immigrant Latino men. METHODS We explored the factor structure and calculated correlations to examine associations between the ISSS subscales and self-esteem, mastery, and depression. RESULTS Mean age of the 244 participants was 26.9 years old and most were from Mexico, had less than high school educational attainment, and worked in construction. The ISSS did not perform as well as expected. CONCLUSIONS Although the ISSS may prove useful as we begin to conceptualize the role and meaning of social support within the context of immigration, more research is needed to develop meaningful measures of constructs among immigrant Latinos in the United States.

Listening to the voices of Latina women: Sexual and reproductive health intervention needs and priorities in a new settlement state in the United States

ABSTRACT Latina women in the United States are disproportionately affected by negative sexual and reproductive health outcomes. Our community-based participatory research partnership conducted in-depth interviews exploring sexual and reproductive health needs and priorities with 25 Latinas in North Carolina and identified themes through constant comparison, a grounded theory development approach. Participants described individual-, interpersonal-, and clinic-level factors affecting their sexual and reproductive health as well as potentially successful intervention characteristics. Our findings can be used to inform culturally congruent interventions to reduce sexual and reproductive health disparities among Latinas, particularly in new settlement states in the southeastern United States.

The ecology of sexual health of sexual minorities in Guatemala City

Guatemalan gay and bisexual men, men who have sex with men (MSM), and transgender persons carry disproportionate burden of HIV and other sexually transmitted infections compared with other Guatemalan subgroups. However, little is known about the determinants of sexual health to inform health promotion and disease prevention interventions among these sexual minorities. We sought to explore sexual health and HIV risk among Guatemalan sexual minorities, using a community-based participatory research approach. We conducted 8 focus groups (n = 87 participants total) and 10 individual in-depth interviews with gay and bisexual men, MSM, and transgender persons. Using constant comparison, an approach to grounded theory, we analyzed verbatim transcripts and identified 24 themes that we organized into five ecological factors influencing sexual health: intrapersonal (e.g. misconceptions about HIV transmission, low perceived susceptibility and lack of condoms use skills); interpersonal (e.g. family rejection and condom use as a barrier to intimacy); community (e.g. discrimination and stigma); institutional (e.g. limited access to health promotion resources); and public policy (e.g. perceived lack of provider confidentiality and anti-gay rhetoric). There is profound need for multiple-level interventions to ensure that Guatemalan sexual minorities have the knowledge and skills needed to reduce sexual risk. Interventions are warranted to increase social support among sexual minorities, reduce negative perspectives about sexual minorities, develop institutional resources to meet the needs of sexual minorities and reduce harmful anti-gay rhetoric. Understanding and intervening on the identified factors is especially important given that the health of Guatemalan sexual minorities has been to-date neglected.