Latinos and HIV epidemic

Intervention "effective program" for Latino youth

Intervention works equally well with boys and girls

Too few scientifically tested HIV prevention interventions target Latino men and women, and even fewer are specifically designed for Latino youth, an expert says.

So it should interest HIV providers and service organizations that there is a new intervention that targets precisely that population, and it recently has been designated as a part of the effective programs for replication by the Centers for Disease Control and Prevention (CDC) of Atlanta, GA.

Called Cuidate! A culturally-based program to reduce HIV sexual risk behavior among Latino youth, the intervention is based on social cognitive theory and the theories of reasoned action and planned behavior.1

The intervention is a replication project itself, since researchers built on the work of the "Be Proud, Be Responsible" intervention that is designed for African American adolescents, says Antonia M. Villarruel, PhD, FAAN, professor and the Nola J. Pender Collegiate Chair in Health Promotion and director of the Center for Health Promotion at the University of Michigan's School of Nursing in Ann Arbor, MI.

Villarruel researched the cultural influences among Latinos in the United States, to understand how they influence safer sex behavior.

For example, studies have shown that Latino youth are more likely to delay sexual intercourse than are their non-Latino peers, Villarruel notes.

"But when Latino adolescents do have sex, they are less likely to use contraception or condoms, and that's the behavior we have to change," she says. "We need to support what is their strength and teach them other skills to use when they are sexually active."

A randomized, controlled trial involving more than 600 youths found that the HIV risk-reduction intervention had significant effects on reducing sexual intercourse among youths than did the health-promotion intervention, which was the comparison intervention.1

Also, the HIV risk-reduction intervention resulted in adolescents reporting having fewer multiple partners, and they reported more consistent condom use.1

These positive findings were true for both male and female youths, Villarruel says.

Some people would be surprised that there was no difference between boys and girls because they advocate for separate HIV prevention programs for girls, she notes.

But with this six-module group session intervention, the inclusion of both genders appeared to have a positive impact on the youths.

"I think it was powerful having both genders there, and that's what the kids said," Villarruel says. "They said they preferred having mixed groups."

For example, in one session, the discussion centered on condom use, which is always a difficult topic for young women to discuss with their partners. In this session, a very attractive teenage boy told the group that he would respect a girl who asked him to use a condom because it would mean the girl was looking out for him, Villarruel recalls.

Hearing from a male peer that condom discussions are okay made it far more likely that the girls would initiate condom discussions with their partners in the future than if the girls were simply told by an adult that it was okay to ask boyfriends to use condoms, she adds.

Investigators are working on developing a training manual, facilitator curriculum, technical assistance, and other material that can be shared with other organizations or clinics that would like to use this intervention, Villarruel says.

The intervention is geared toward youths, ages 13 to 18, and the community workers who served as facilitators were trained to follow the curriculum in providing the six, 50-minute modules to mixed gender groups. The modules were provided in either Spanish or English.1

The facilitators did not need more than a high school education, but they had to have basic skills in communicating with teenagers about sexual behavior and condom use, Villarruel says.

Facilitators received 2.5 days of training, which included building skills in providing a supportive and open environment, Villarruel says.

"We taught them how to deal with adolescents; how to be concrete, and to understand why we're repetitive throughout the curriculum," she says. "We taught them how to provide an open environment in which youths can ask questions and are not attacked within the group."

"Using the program is low-cost, with expenses being investments in training and time for persons to deliver the program," she notes. "I think the training is very effective as well, and we've had a good deal of fidelity to the intervention."

Researchers recruited youths, mainly of Puerto Rican descent, from Philadelphia high schools and community-based organizations, and eligibility was based on their being self-identified as Latino, ages 13 to 18, and having provided assent and parental consent.1

The health-promotion intervention focused on diet, exercise, and physical activity, as well as cigarette, alcohol, and drug use.1

The HIV prevention intervention focused on HIV transmission and behaviors that could prevent infection, Villarruel says.

"We share the story of the epidemic and focus on the transmission of HIV and building skills to protect themselves," she says.

Reference:

1. Villarruel AM, et al. A randomized controlled trial testing an HIV prevention intervention for Latino youth. Arch Pediatr Adolesc Med. 2006;160:772-777.