Intervention reaches Latino men at soccer games

Finding target audience is the challenge

One of the challenges in targeting Latinos in the United States for HIV prevention messages has been the diversity of this ethnic group, both culturally and geographically.

Investigators at Wake Forest University in Winston-Salem, NC, have found that designing HIV interventions for Latinos requires some creativity and time spent on getting to know the target audience in any specific town or area.

"We contend the Hispanic population we're working with in the Southeast is very different from Hispanics in California," says Scott D. Rhodes, PhD, MPH, an associate professor at Wake Forest University, division of public health sciences/social sciences and health policy in the school of medicine.

It's difficult identifying a prevention approach that will work, as well as to identify ways to find the target audience, Rhodes says.

"We tried to find out what was going on for these men and what would be their outlets," he says.

While HIV prevention services often conduct outreach in community churches, this might not be the best way to reach the Latino men who are most at risk, he notes.

"People are always pushing the importance of a church and say a church is the way to reach people," Rhodes says. "What we've learned is that if you go to a church, you probably have a family there with you, and if you don't go to a church, then you might be a single man who is most at risk."

Also, there's sort of a brothel system in the Southeast and in rural communities, which adds to the risk of transmitting HIV, he says.

Latino men say there are advantages to living in the Southeast, including cheaper housing, but on the negative side, the health care infrastructure is not as strong, Rhodes says.

"Their access to health services is lower here, and we don't have a history of providing bilingual services," Rhodes adds.

California has a long history of providing bilingual services, and Hispanics in California can be more easily reached for HIV interventions, he adds.

Given these differences, it does not make sense to use in cookie cutter style any HIV prevention intervention that was designed for a Latino community in California.

"So we wanted to explore sexual priorities and health among Latino men," Rhodes says. "And we wanted to see what is the best way to recruit and work with Latino men in the Southeast."

The answer turned out to be soccer leagues.

"We found that soccer leagues were a community asset that allowed us to partner with Latino men," Rhodes says. "So we use a lay health provider approach where we train men from a soccer team on basic HIV and sexually transmitted disease (STD) information."

One of the important findings in the prevention research was that Latino participants helped investigators understand their social networks.

"Our participants said, 'We help each other get driver's licenses, buy cars, find housing, and we use family and friendship networks,'" Rhodes recalls. "We knew we should be using these networks to help prevent infection and disease."

For example, as the network helps newcomers obtain the essentials of living in the United States, they could also provide men with free condoms and show them how to receive health care and get tested for HIV, he says.

In exchange, the peer leaders received a monthly stipend of $50 as payment for their data collection.

"They had to give us low literacy activity logs so we could figure out who they were talking to," Rhodes explains. "Half of their work as lay advisers went beyond the soccer league."

Researchers taught these leaders how to access health services in their local community; they trained them to be opinion leaders, and they gave them condoms to use.

"We used a penis model to show people whether they're using the condoms correctly," Rhodes notes. "The men were very eager to learn these things and help their community, and they wanted to participate and be part of the project."

Investigators found that sexual health is a priority among the Latino men they targeted.

"We collected information monthly on how to access care and changing cultural norms," Rhodes says. "We didn't give condoms to women or talk about sexual health with women."

Researchers trained Latino community leaders to teach their peers that it is okay to seek help when they need it.

"We trained Latino advisors to teach teammates that it's okay for men to go to the health department to obtain information about STDs," Rhodes says. "This approach seems to be effective."

Investigators still are analyzing the outcomes data, Rhodes says.

The project began with focus groups.

"We were doing qualitative data collection, using focus groups, and we wanted to do it with Latino men," Rhodes says. "We worked with the director of a soccer group to get men in."

What they found was that the soccer league is a very important community asset among Latinos in the Southeast, he says.

This was an important find for researchers because it's very difficult to market HIV prevention services to a little-known group.

"We don't know what they're eligible for and where they'd get access to services if they were eligible," Rhodes says. "Many of these men are undocumented, and they don't want to seek assistance."

Their reluctance to seek health care services has the effect of understating their presence in the community, and this leads to health care institutions understaffing with bilingual staff.

"We have a very complicated health care system that's different from the community these folks come from," Rhodes explains. "So understanding how to access services is tough, and having only an occasional interpreter makes it very difficult."

Plus, there are huge racial tensions in the Carolinas, particularly about immigration, he adds.

"These tensions are felt by the Latino community," Rhodes says.