Library

Instruments:

• Condom use for females in English
• Condom use for males in English
• Uso de condones para mujeres en Español
• Uso de condones para hombres en Español

Scoring: Please read the detailed description of the instruments. Reliability and/or validity: “Condom use among Hispanic men with secondary female sexual partners” by Barbara VanOss Marin, Cynthia A. Gomez, and Jeanne M. Tschann, printed in Public Health Reports; also in Gómez C, Marín BV (1996). Gender, culture, and power: Barriers to safe sex. Journal of Sex Research, 33(4), 355–362.

Instrument: HIV treatment adherence self-efficacy scale Scoring: Included in article Reliability or validity: Johnson MO, Neilands TB, Dilworth SE, Morin SF, Remien RH, Chesney MA. The Role of Self-Efficacy in HIV Treatment Adherence: Validation of the HIV Treatment Adherence Self-Efficacy Scale (HIV-ASES). J Behav Med. 2007 Jun 23.

What is the role of adherence in HIV treatment?

Why is adherence important?

The introduction of highly active antiretroviral therapy (HAART) has extended and improved the quality of life for people living with HIV by reducing viral load, often to undetectable levels. However, the initial enthusiasm for these drugs has been dampened somewhat by the discovery that they require near perfect adherence to prevent virus replication and mutation. Studies have shown that 95% adherence is needed for viral suppression and that even a small decrease in adherence can greatly increase viral load.¹ If the virus is allowed to mutate into drug resistant strains, the treatment regimen can become ineffective, which reduces treatment options both for the non-adherent individuals and for any partners they may infect with these strains.²

How do you measure adherence?

Adherence is usually measured through self-report, pill count, electronic pill bottle caps (MEMS caps) and laboratory tests.³ Self-report through doctor’s office visits, questionnaires, structured interviews or diaries provides a simple and practical way of determining the self-perceived level of adherence.⁴ However, many individuals forget whether or not they took all their pills or may forget to complete their diary every day, and others may misrepresent their adherence in order to please the interviewer or clinician. Diaries may also not be feasible in settings where literacy is an issue. Pill count, particularly if unannounced, may provide a more accurate assessment of adherence rates than self-report. However, it is labor intensive and may be perceived as intrusive, especially if conducted during unannounced home visits. In such situations, in-clinic pill count may work better. MEMS caps record each time the bottle cap is removed by the patient. They have been found to correlate highly with concurrent viral load. However, they are expensive to use and may under-report adherence in patients who remove more than one dose at a time for using medi-sets pill organizers.⁶ All of these methods assume that patients have actually taken all missing pills. Laboratory tests, an indirect measure of adherence, can include viral load, CD4 counts, and blood levels of drug metabolites. These measures are less commonly used and very expensive. The results give no specific information about number of doses missed or adherence to medication schedule. They can also be influenced by other factors, such as the presence of drug resistant virus. Still, lab measures are often considered a useful adherence measure when combined with patient self-report and/or pill counts.

What are barriers?

Adhering to medications is hard to do. Most people have a problem finishing even a 5-day dose of antibiotics. Adherence is even more difficult when taking multiple drugs with different dosing requirements and severe, unpleasant side effects such as diarrhea, nerve damage and changes in body composition. Many people with HIV also have other complicating factors in their lives, including mental health issues, economic worries, lack of stable housing and alcohol or drug use, making it difficult to prioritize adherence. Adherence barriers are often divided into regimen-specific, social/psychological and institutional. Regimen-specific issues, such as the complexity of the treatment and taking many pills at different times, as well as side effects of the medication, can lead persons to miss doses.⁸ Scheduling demands such as work, travel and mealtimes can also be barriers. Social and psychological factors influence adherence. Mental health issues (such as depression or psychological distress), attitudes toward treatment and toward HIV, and support from health care workers, family and friends are key to adherence.⁹ Positive responses promote adherence and negative responses (lack of support, pessimism, etc.) can make it more difficult to adhere to treatment regimens. Institutional factors such as incarceration, clinic setting and access to reliable health care and medication affect adherence. Factors that promote adherence are pleasantness of the clinic, convenience of scheduling, confidentiality and availability of transportation and childcare.¹⁰

What’s being done?

Action Point, a storefront drop-in center in San Francisco, CA, offers adherence support for the urban poor with active drug or alcohol addiction. Located in an area of high rates of drug-related arrests and deaths, Action Point is open 6 days a week and operates on a harm reduction principle that encourages any positive change in health. The program offers adherence case management, prescription dispensing, nursing care, acupuncture and referrals to mental health and substance abuse services. After one month of enrollment, clients are offered a pager that receives e-mail messages to remind clients to take their medications. After six months, 61% of Action Point clients were taking HAART and 81% reported greater than 90% adherence.¹¹ In New York, patients who had not previously been on HAART were offered an individualized, three-module program on basic understanding of HIV, adherence and regimen options. Counselors discussed with each patient in detail potential adherence barriers, anticipated toxicities, pill burdens, dosing intervals and drug preferences. These were evaluated, reported to their provider and used to select an individualized regimen. Patients were given tools such as pillboxes, dose cards and beepers, if needed. They also provided intensive coaching and a dedicated phone line for patients. The program increased adherence and enhanced virologic response.¹² One promising new adherence strategy is directly observed therapy (DOT) for antiretrovirals, or DAART. Based on DOT for tuberculosis, DAART has been used in settings where patients have frequent interactions with health care workers, such as prisons and methadone maintenance clinics. Some complications of using DAART include the fact that medications need to be taken for a lifetime and dosing is usually more than once a day.¹³

What can we do?

Because adherence to HAART is a complex process, interventions to improve adherence are best designed to be multifaceted. Factors to consider include regimen complexity, side effects, patient-related factors and even the patient-health care worker relationship, each of which affects adherence to medications. Overall, the better that a regimen “fits” with a patient’s lifestyle, the greater adherence is likely to be.¹⁴ Health care workers can help increase adherence by: involving the patient in selecting a regimen with tolerable dosing schedules; preparing for and managing side effects; addressing and treating mental health and drug use issues; addressing concrete issues such as lack of transportation and homelessness; providing memory aids and anticipating treatment fatigue.¹⁵ Patients can help by: learning about HIV disease and anti-HIV drugs and what they do; finding treatment goals that are not HIV-related (seeing children grow up, remaining healthy and looking good); recruiting friends or family to act as adherence monitors and anticipating changes in routine such as travel.¹⁵

What needs to be done?

Everyone can be adherent with proper support. HIV+ persons may combat not just HIV disease, but drug addiction, homelessness and/or incarceration. Many of the barriers to adherence can be overcome with treatment and the right tools. For example, depression and other mental health problems that get in the way of optimal adherence are often treatable and should be diagnosed and treated. Because adherence is complex, it often requires an “adherence team.” Collaboration between the patient, physician, nurse, case manager, social worker, pharmacist, counselor and family or friends is essential.

Says who?

1. Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of Internal Medicine. 2000;133:21-30. 2. Bangsberg DR, Deeks SD. Is average adherence to HIV antiretroviral therapy enough? Journal of General Internal Medicine. 2002;17:812-813. 3. Fogarty L, Roter D, Larson S et al. Patient adherence to HIV medication regimens: a review of published and abstract reports. Patient Education and Counseling. 2002;46:93-108. 4. Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG Adherence Instruments. AIDS Care. 2000;12:255-266.https://pubmed.ncbi.nlm.nih.gov/10928201/  5. Samet JH, Sullivan LM, Traphagen ET, et al. Measuring adherence among HIV-infected persons: is MEMS consummate technology? AIDS and Behavior. 2001;5:21-30. 6. Wendel CS, Mohler MJ, Kroesen K, et al. Barriers to use of electronic adherence monitoring in an HIV clinic. The Annals of Pharmacotherapy. 2001;35:1010-1015. 7. Ickovics JR, Meade CS. Adherence to HAART among patients with HIV: breakthroughs and barriers. AIDS Care. 2002;14:309-318. 8. Altice FL, Mostashari F, Friedland GH. Trust and acceptance of and adherence to antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes. 2001;28:47-58. 9. Gordillo V, Del Amo J, Soriano V, et al. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS. 1999;13:1763-1769. 10. Ciccarone D, Bangsberg D. , Bamberger J, et al. HIV-Related hospitalization before and during participation in ‘Action Point’ an adherence case management program. Presented at the American Public Health Association Conference. 2003. 11. Bamberger JD, Unick J, Klein P et al. Helping the urban poor stay with antiretroviral HIV drug therapy. American Journal of Public Health. 2000;90:699-701. 12. Esch L, Hardy H, Wynn H, et al. Intensive adherence interventions improve virologic response to antiretroviral therapy (ART) in naive patients. Presented at the 8th Conference on Retroviruses and Opportunistic Infections, Chicago, IL. 2001. Abst #481. 13. Lucas GM, Flexner CW, Moore RD. Directly administered antiretroviral therapy in the treatment of HIV infection: benefit or burden? AIDS Patient Care and STDs. 2002;16:527-535. 14. Chesney MA, Malow RM. Adherence in Chronic Diseases: Lessons learned from HIV/AIDS. World Health Organization volume on Adherence in Chronic Diseases. in press 15. Bartlett JA. Addressing the challenges of adherence. Journal of Acquired Immune Deficiency Syndromes. 2002;29:S2-S10. For information on how this affects prevention, please see Fact Sheet #27 “Do new HIV drugs affect HIV prevention?”

Prepared by Maria Ekstrand, Michael Crosby and Pamela DeCarlo, CAPS January 2003. Fact Sheet #47E Special thanks to the following reviewers of this Fact Sheet: Margaret Chesney, Linda Fogarty, Celia Friedrich, Jeanette Ickovics, James L. Sorensen.

Reproduction of this text is encouraged; however, copies may not be sold, and the Center for AIDS Prevention Studies at the University of California San Franciso should be cited as the source of this information. For additional copies of this and other HIV Prevention Fact Sheets, please call the National Prevention Information Network at 800/458-5231. Comments and questions about this Fact Sheet may be e-mailed to [email protected]. © January 2003, University of California

How does disclosure affect HIV prevention?

why is disclosure important in HIV?

Disclosure of HIV+ status is a complex, difficult and very personal matter. Disclosing one’s HIV+ status entails communication about a potentially life threatening, stigmatized and transmissible illness. Choices people make about this are not only personal but vary across different age groups, in different situations and contexts, and with different partners, and may change with time, depending on one’s experiences. Disclosure may have lifelong implications since more people are living longer, and often asymptomatically, with HIV. Public health messages have traditionally urged disclosure to all sexual and drug using partners. In reality, some HIV+ persons may choose not to disclose due to fears of rejection or harm, feelings of shame, desires to maintain secrecy, feelings that with safer sex there is no need for disclosure, fatalism, perceived community norms against disclosure, and beliefs that individuals are responsible for protecting themselves.¹ This Fact Sheet primarily focuses on disclosure in the context of sex. Discussing and disclosing HIV status is a two-way street. Be it right or wrong, most people feel that when a person knows that he/she is HIV+ then he/she has an obligation to tell the other person, and counselors are encouraged to help people with this process. Also, laws in some areas require disclosure of HIV+ status prior to sex.² However, both partners should be responsible for knowing their own status, disclosing their own status when it seems important, and asking their partner about their status if they want to know. Most HIV+ persons disclose their status to some, but not all, of their partners, friends and family. Disclosure generally becomes easier the longer someone has been living with HIV, as he/she becomes more comfortable with an HIV+ status. Disclosure to sex partners is more likely in longer-term, romantic relationships than in casual relationships (one-night stands, anonymous partners, group scenes, etc.).³ Disclosure also varies depending on perceived HIV status of partners, level of HIV risk of sex activities, sense of responsibility to protect partners (personal vs. shared responsibility) and alcohol or drug use.

does disclosure affect sexual relationships?

The relationship between disclosure, sexual risk behaviors and potential transmission of HIV varies. Research findings have presented a mixed picture.⁴ Some studies have found that increased disclosure is associated with reduced sexual risk behavior.⁵ Other studies show that disclosure doesn’t always alter risk taking behaviors.⁶ Even with disclosure, unsafe sex sometimes occurs. Some people engage in safer sex behaviors without any discussion of HIV status.⁷ Disclosure can provide psychological benefits. In one study, HIV+ injection drug users who disclosed their status experienced increased intimacy with partners and reaffirmation of their sense of self.⁸ Many HIV+ persons who disclose their status find that it reduces anxiety about transmission, so sex can be much more comfortable and relaxed. A challenging issue for many people is the timing of disclosure. If it’s not done relatively early, it can become more difficult as time goes on, and can cause significant disruption to an ongoing relationship if the disclosed-to partner feels betrayed due to the lack of an earlier disclosure. HIV+ persons who have thought through a disclosure plan and have a consistent strategy for managing disclosure are less likely to engage in risky sexual behaviors than those who do not disclose or have inconsistent disclosure strategies.⁵

does disclosure affect social relationships?

Yes. Disclosure to significant others can help increase support for HIV+ persons. A study of Latino gay men found that disclosure was related to greater quality of social support, greater self-esteem, and lower levels of depression.⁹ Disclosure also can lead to support that facilitates initiation of, and adherence to, HIV treatment and medications.^10,11 Disclosing HIV+ status can and sometimes does result in rejection, discrimination or violence. Disclosing to certain persons also can be more of a burden than a benefit. One study found that friends were disclosed to most often and perceived as more supportive than family members, and mothers and sisters were disclosed to more often than fathers and brothers and perceived as more supportive than other family members.¹²

what are the controversies?

There is debate around whether partners have a right to know if their partner is HIV+, in order to be able to make a fully informed decision about what sexual behavior to engage in. Some HIV+ persons believe that if they only have protected sex, there is no need for disclosure, especially with casual partners, and that encouraging disclosure only serves to further stigmatize HIV+ persons. These issues can be complicated by complex gender role norms and local laws—23 states have laws that make it a crime for a person to engage in certain risk behaviors without disclosing their HIV status.² People may use disclosure as a way to limit their partners to only persons of the same status, be it HIV+ or HIV- (sometimes known as serosorting). The success of serosorting as a prevention strategy depends upon honest and accurate disclosure on the part of any two sexual partners.¹³ Even when persons do choose to disclose, their awareness of their own HIV status may not be accurate.¹⁴ For example, some people who think that they are HIV- may be, in fact, in the acute stage of HIV infection. If an individual is in the acute stage of HIV infection, which are the initial weeks to months after acquiring HIV when the body has not yet produced a detectable antibody response, then he or she will have a negative result on a standard HIV test. This is especially concerning because when people are in this stage of infection, they more readily transmit the virus during unprotected sex than at other times.¹⁵

what’s being done?

Because many experts believe that HIV+ status disclosure helps prevent HIV transmission and increases social support for HIV+ individuals, there are efforts to develop programs to encourage disclosure and make it a constructive experience. Most programs to support HIV status disclosure have been part of overall prevention and well-being programs for HIV+ persons. Programs may include discussions of the benefits of disclosure, when to disclose and to whom. Programs should include practicing skills to discuss HIV status in the context of sexual negotiation and dating. The Healthy Living Project is a 15-session, individually delivered, cognitive behavioral intervention to help HIV+ persons cope with the challenges of living with HIV. The project addressed issues of stress, coping and adjustment, safer behavior, including disclosure to partners, and health-related behaviors. Participants reported fewer unprotected sexual risk acts with persons of HIV- or unknown status.¹⁶ Healthy Relationships is a 5-session, small-group skills-building program for HIV+ persons, and is one of the CDC’s Diffusion of Effective Interventions (DEBI). It is designed to reduce participants’ stress related to safer sexual behaviors and disclosure of their HIV status to family, friends and sex partners. Participants reported significantly less unprotected intercourse and greater condom use at follow-up.¹⁷ Other disclosure approaches have aimed at encouraging both HIV+ and HIV- persons to not make assumptions about their partner’s HIV status, to get tested, to disclose their own status and practice safer sex with all partners. The Department of Public Health in San Francisco, CA, created the Disclosure Initiative social marketing campaign which aims to normalize the disclosure of HIV status for both HIV+ and HIV- men.¹⁸

what needs to be done?

We need to normalize and facilitate comfortable discussions about HIV, so that disclosure of HIV+ status isn’t such a difficult thing to do. The more HIV is talked about, and the more people come out about being HIV+, the less stigma there will be. Disclosure is a two-way street. That means it is up to both people who are having sex with each other to address the issue. People living with HIV often are much happier in their relationships (long and short-term) when their HIV status is known by their partner. There’s no simple answer or policy for disclosure of HIV. Clinicians, counselors and programs need to be sensitive to the complexity of disclosure, and understand that disclosure is not for all people in all contexts. However, disclosing one’s HIV status can facilitate support for HIV+ persons and may lead to better communication, including discussion of risk reduction practices between sexual partners.

Says who?

1. Wolitski RJ, Parsons JT, Gómez CA, et al. Prevention with HIV-seropositive men who have sex with men: lessons from the Seropositive Urban Men’s Study and the Seropositive Urban Men’s Intervention Trial. Journal of AIDS. 2004;37:S101-109. 2. Galletly CL, Pinkerton SD. Conflicting messages: how criminal HIV disclosure laws undermine public health efforts to control the spread of HIV. AIDS and Behavior. 2006;10:451-461. 3. Duru OK, Collins RL, Ciccarone DH, et al. Correlates of sex without serostatus disclosure among a national probability sample of HIV patients. AIDS and Behavior. 2006;10:495-507. 4. Simoni JM, Pantalone D. Secrets and safety in the age of AIDS: does HIV disclosure lead to safer sex? Topics in HIV Medicine. 2004;12:109-118. 5. Parsons JT, Schrimshaw EW, Bimbi DS, et al. Consistent, inconsistent, and non-disclosure to casual sex partners among HIV-seropositive gay and bisexual men. AIDS. 2005;19:S87-S97. 6. Crepaz N, Marks G. Serostatus disclosure, sexual communication and safer sex in HIV-positive men. AIDS Care. 2003;15:379-387. 7. Klitzman R, Exner T, Correale J, et al. It’s not just what you say: Relationships of HIV dislosure and risk reduction among MSM in the post-HAART era. AIDS Care. 2007;19:749-756. 8. Parsons JT, VanOra J, Missildine W, et al. Positive and negative consequences of HIV disclosure among seropositive injection drug users. AIDS Education and Prevention. 2004;16:459-475. 9. Zea MC, Reisen CA, Poppen PJ, et al. Disclosure of HIV status and psychological well-being among Latino gay and bisexual men. AIDS and Behavior. 2005;9:15-26. 10. Stirratt MJ, Remien RH, Smith A, et al. The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS and Behavior. 2006;10:483-493. 11. Klitzman RL, Kirshenbaum SB, Dodge B, et al. Intricacies and inter-relationships between HIV disclosure and HAART: a qualitative study. AIDS Care. 2004;16:628-640. 12. Kalichman SC, DiMarco M, Austin J, et al. Stress, social support, and HIV-status disclosure to family and friends among HIV-positive men and women. Journal of Behavioral Medicine. 2003;26:315-332. 13. Cairns G. New directions in HIV prevention: serosorting and universal testing. IAPAC Monthly. February 2006:42-45. 14. MacKellar DA, Valleroy LA, Behel S, et al. Unintentional HIV exposures from young men who have sex with men who disclose being HIV-negative. AIDS. 2006;20:1637-1644. 15. Pilcher CD, Eron JJ, Galvin S, et al. Acute HIV revisited: new opportunities for treatment and prevention. Journal of Clinical Investigation. 2004;113:937-945. 16. The Healthy Living Project Team. Effects of a behavioral intervention to reduce risk of transmission among people living with HIV: the Healthy Living Project randomized controlled study. Journal of AIDS. 2006; 44:213-221. 17. Kalichman SC, Rompa D, Cage M, et al. Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. American Journal of Preventive Medicine. 2001;21: 84-92. Program information 18. hivdisclosure.com All websites accessed July 2007.

Prepared by Robert H. Remien and Mark Bradley HIV Center for Clinical & Behavioral Studies, NY State Psychiatric Institute and Columbia University July 2007. Fact Sheet #64E Special thanks to the following reviewers of this fact sheet: Mark Cichocki, Joe Imbriani, Phebe Lam, Jennifer Lewis, Bradford McIntyre, Bob Munk, Michael Paquette, Tom Patterson, Steve Pinkerton, Jane Simoni, Jef St De Lore, David Vance, John K. Williams. Reproduction of this text is encouraged; however, copies may not be sold, and the University of California San Francisco should be cited as the source. Fact Sheets are also available in Spanish. To receive Fact Sheets via e-mail, send an e-mail to [email protected] with the message “subscribe CAPSFS first name last name.” ©July 2007, University of CA.

What are the HIV prevention needs of Latino gay men in the US?

Fact Sheet 28, March 2012

Why focus on Latino gay men?

The ever changing mosaic of Latino demographics in the US creates unique challenges to address health disparities of the population, especially when it comes to HIV prevention needs.  Latinos are the largest and fastest growing ethnoracial minority group in the US, experiencing a 43% growth between 2000 and 2010¹. Data also show that Latinos are one of the fastest growing populations at risk for HIV transmission:

• Latino men who have sex with men (MSM^*) represent 81% of new infections among Latino men, and 19% among all MSM^2,3
• Latinos are 16% of the US population, but make up 17% of living HIV/ AIDS cases and 20% of new HIV infections each year³
• Youth (ages 13-29) accounted for 45% of new HIV infections among Latino MSM⁴

In light of these data there is a need to identify culturally-specific health concerns of Latino gay men so that effective interventions may be developed to address current and prevent future disparities. The US National HIV/AIDS Strategy highlights the call for HIV programs that reduce health inequities among both ethnoracial and sexual minority populations⁵.  Latino gay men have distinct cross-cultural identities that place them into both prioritized categories⁶.

What are the prevention challenges?

Most work related to Latino gay men has been based on a sociocultural model of health, which shows that experiences of social discrimination, defined as racism, homophobia and poverty, are strong predictors of mental health outcomes⁷. Mental health outcomes, such as psychological distress, have been shown to increase sexual risk and decrease sexual resiliency. A recent study of Latino MSM living in New York and Los Angeles⁸ reported that:

• Over 40% of the participants reported experiences of both racism and homophobia in the past year
• Low self-esteem and decreased levels of social support among Latino gay men are associated with increased rates of sexual risk behaviors, including unprotected anal sex
• Men who had both homophobic and racist experiences were more likely than men who reported no form of discrimination to engage in unprotected anal sex as a bottom, and to also be binge drinkers

Late testing (that is, those individuals who have an AIDS diagnosis within one year of testing HIV-positive) and lack of access to health insurance also create challenges to prevention, treatment and care.

• 38% of Latinos test late in their illness⁹.
• In a study of 21 major US cities, 46% of Latino MSM who tested positive for HIV were unaware of their infection³.
• HIV+ Latinos are more likely than Whites to postpone care due to issues such as lack of transportation, and more likely to delay initiation of care after their diagnosis⁹.
• 24% of Latinos living with HIV/ AIDS are uninsured, compared to 17% of Whites; and only 23% of HIV+ Latinos have private health insurance, compared to 44% of Whites¹⁰.

Reviews of research with Latino gay and bisexual men also report that cultural influences and socioeconomic forces impact sexual well being. For example, residency status, HIV-related stigma, machismo, immigration and migration patterns, language, insurance status and educational attainment have all been associated barriers to HIV prevention services and programming^{11, 12}

What other factors affect sexual risk and resiliency?

Latino gay men are often faced with unique socio-sexual situations that place them at risk for HIV transmission. Prior work with MSM populations, including Latino gay men, has documented that various factors are associated with sexual-risk:

• Serosorting (choosing sexual partners based on perceived HIV status), seropositioning (choosing sexual roles [e.g., top or bottom] based on the perceived HIV status of each partner), and sexual stereotypes and preferences¹³
• Alcohol and drug use (including methamphetamine and injection use), as well as having had a history of STDs, like syphilis and gonorrhea^14,15
• High rates of condomless anal sex (“barebacking”) and multiple partners¹⁶
• Childhood sexual abuse and a social context of discrimination¹⁷

Defined as adopting cultural ways of mainstream society, work on acculturation suggests that: Latinos who are less acculturated to mainstream US culture are protected by traditional Latino (sexual) values; and that acculturation of US mainstream values serves as a protective barrier because it increases a sense of individualism and self-determination¹⁸ Understanding the role of sociocultural factors helps to refine definitions of sexual resiliency among Latino gay men. Innovative work exploring protective factors among Latino gay men notes that: HIV prevalence was higher among US born than non-US born Latinos in San Francisco, while in Chicago the opposite was true¹⁹

• Community involvement moderates sexual risk behaviors²⁰
• Volunteering with HIV/ AIDS organizations can decrease psychological stressors²⁰

As the majority of these data came from quantitative surveys, more public health focused qualitative studies are needed to further examine the context of the sexual situations in which Latino gay men find themselves, as well as the cultural factors and sexual scripts²¹ that influence their harm reduction behaviors.

What is being done?

• Hermanos de Luna y Sol, born out of the Mission District in San Francisco, CA is a longstanding HIV prevention intervention for immigrant Spanish speaking Latino gay and bisexual men that is based on empowerment education and social support, and has been successful in increasing condom use among participants²².
• Latinos D (based in Queens, NY²³) and Somos Latinos Salud (based in Ft. Lauderdale, FL²⁴) are dynamic and promising adaptations of the MPowerment program, an effective community-level, evidence-based HIV intervention for young gay and bisexual men²⁵.
• SOMOS, a homegrown and culturally responsive NYC-based HIV prevention program, has been shown to lower risk behaviors and decrease number of sexual partners among Latino gay men²⁶.

Still, even with these programs and CDC recommendations to address Latino MSM health disparities, most adaptations of evidence-based interventions have largely been linguistically, but not necessarily culturally, translated versions of established programs.

What are the recommendations?

• Celebrate the diversity of Latino cultures in programming. Different experiences of historical events, political environments, immigration patterns and regional cultures exist within Latino communities (e.g., Chicanos in Los Angeles, Nuyoricans in New York, Tejanos in San Antonio).
• Conduct more research on structural and environmental influences on Latino gay men’s sexual health including issues relating to undocumented HIV+ Latinos.
• Understand that serving populations is not the same as being culturally competent. Including Latino participation does not equate to providing appropriate services.
• Cultivate Latino gay community collaboration and empowerment by ensuring that Latino gay men participate in local HIV prevention and care planning councils.
• Develop programs that address the unique concerns of both immigrants and U.S. born Latino gay men. Assuming that all Latino gay men are monolingual Spanish speakers minimizes the needs of bicultural (but not necessarily bilingual) Latino gay men.
• Reduce gay-related and HIV-related stigmas in Latino communities. Breaking sexual silences will help promote healthy sexual identity development.
• Work with policy makers and political stakeholders to advocate for sustainable health care access.
• Highlight social norms and cultural values that enhance sexual resiliency. Focusing solely on risk factors leads to limited insights and opportunities for interventions.
• Foster programs that address the impact of isolation and identity validation. Lessening stressors that Latino gay men face will improve their overall well-being.

Says who?

1 US Census Bureau (2011).  Overview of Race and Hispanic Origin: 2010 – U.S. Census Bureau. 2 CDC. (2011). CDC Fact Sheet: HIV and AIDS among Latinos.  3 CDC. (2008).  HIV Surveillance in Men Who Have Sex with Men (MSM). https://www.cdc.gov/hiv/group/msm/index.html. 4 Prejean J, et al. (2011). Estimated HIV Incidence in the United States, 2006-2009. PLoS ONE. 5 ONAP. (2010). National HIV/AIDS Strategy: Federal Implementation Plan. https://www.hiv.gov/federal-response/national-hiv-aids-strategy/federal-implementation#:~:text=The%20Federal%20Action%20Plan%20presents,within%203%20to%205%20years. 6 Diaz, RM (1998). Latino gay men and HIV: culture, sexuality, and risk behavior. Routledge. 7 Díaz RM, et al. (2001). The impact of homophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. Am J Public Health. 91(6):927-932. 8 Mizuno Y, et al. (2011). Homophobia and Racism Experienced by Latino Men Who Have Sex with Men in the United States: Correlates of Exposure and Associations with HIV Risk Behaviors. AIDS Behav. [Epub ahead of print] 9 CDC. (2011). HIV Surveillance Report, Vol. 21. 10 RAND. (2011). HIV Cost and Services Utilization Study (HCSUS). http://www.rand.org/health/projects/hcsus.html.\ 11 Zea MC, et al. (2004). Methodological issues in research on sexual behavior with Latino gay and bisexual men.  Am J Community Psychol. 31(3-4):281-291. 12 National Latino AIDS Awareness Day. HIV/ AIDS and Latino/ Hispanic men who have sex with men. 13 Rosenberg ES, et al. (2011). Number of casual male sexual partners and associated factors among men who have sex with men: results from the National HIV Behavioral Surveillance system. BMC Public Health. 25: 11-89. 14 CDC. (2010). HIV among Hispanics/ Latinos. https://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/index.html15 Balan IC, et al. (2009). Intentional Condomless Anal Intercourse Among Latino MSM Who Meet Sexual Partners on the Internet. AIDS Educ Prev. 21(1): 14-24. 16 Diaz RM et al. (2005). Reasons for stimulant use among Latino gay men in San Francisco: a comparison between methamphetamine and cocaine users. Journal of Urban Health. 82(Supp1): 71-78. 17 Arreola SG, et al. (2009). Childhood sexual abuse and the sociocultural context of sexual risk among adult Latino gay and bisexual men. Am J Pub Hlth. 99 Suppl 2:S432-8. 18 Abraído-Lanza AF, et al. (2005). Do healthy behaviors decline with greater acculturation? Implications for the Latino mortality paradox. Soc Sci Med. 61:1243–1255. 19 Ramirez-Valles J, et al. (2008) HIV Infection, Sexual Risk, and Substance Use among Latino Gay and Bisexual Men and Transgender Persons. American Journal of Public Health. 98: 1036-1042. 20 Ramirez-Valles J (2002). The proactive effects of community inolvment for HIV risk behavior: A conceptual framework. Health Education Research. 17(4): 389-403. 21 Carrillo H, et al. (2008). Risk across borders: Sexual contexts and HIV prevention challenges among Mexican gay and bisexual immigrant men. Findings and recommendations from the Trayectos Study (Monograph). San Francisco: UCSF and SFSU. 22 Hermanas de Luna y Sol.http://sfresourceconnect.org/detail.php?id=41275840  23 Latinos Diferentes. https://www.facebook.com/LatinosD. 24 Latinos Salud – Somos. http://www.latinossalud.org 25 Mpowerment. http://mpowerment.org. 26 Vega MY, et al. (2011). SOMOS: evaluation of an HIV prevention intervention for Latino gay men. Health Educ Res. 26(3):407-418.

Prepared by Gabriel R. Galindo DrPH, UCSF Center for AIDS Prevention Studies Fact Sheet 28, March 2012 Special thanks to the following reviewers of this Fact Sheet: Ana F. Abraido-Lanza, Sonya Arreola, Maricarmen Arjona, George Ayala, Alida Bouris, Hector Carrillo, Rafael Diaz, Lizette Rivera, Ramon Ramirez and Jesus Ramirez-Valles.

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