Preliminary Results of an HIV/STI Risk Reduction Group Intervention for Hispanic Women

Purpose: Hispanics are disproportionately affected by HIV, relative to white, non-Hispanics. Disparities have persisted in the rate of new HIV infections among Hispanic women. In 2010, the rate of new HIV infections for Hispanic women was 4 times that for white women. In 2013, Hispanics accounted for 21% of the HIV infections and 12% of AIDS deaths. Although Hispanic women are disproportionately affected by HIV, they remain an understudied and underserved population. Few intervention studies have sufficiently large Hispanic sub-samples to evaluate the efficacy of interventions for Hispanics, and few interventions address the cultural context of Hispanic women. The adoption of HIV prevention behaviors is a complex process for Hispanic women. Culturally-specific interventions that address unique risk factors for HIV infection are needed for Hispanic women. Translating research into practice  promote HIV risk prevention and behavioral changes in the Hispanic community. To improve minority health and to eliminate health disparities is of vital importance to overall health and well-being. The purpose of the study is to investigate the preliminary effectiveness of an HIV/STI risk reduction group intervention (SEPA; Salud/Health, Educación/Education, Promoción/Promotion, y/and Autocuidado/Self-care) for Hispanic women.

Methods: 320 Hispanic women between 18 and 50 years old from South Florida participated in a randomized controlled trial of SEPA compared to a delayed-intervention control group. Data was collected on HIV/STI prevention variables at two times, pre-intervention and 6 months post-intervention follow-up, using a web-based research management software system (e-Velos). Participants were recruited through outreach at the Florida Department of Health in Miami Dade County and at public places where Hispanic women go frequently (e.g., churches, supermarkets, community organizations). Assessors were female bilingual interviewers who used a structured questionnaire. Group sessions were facilitated by agency personnel, who were trained by university staff with on-going supervision. We measured the following HIV related outcomes: HIV knowledge, number of main and other sexual partners, and consistent condom use (self-reported 100% use of condoms during vaginal sex). Generalized estimating equations (GEE) was used to test for time x intervention differences in change from pre-intervention to follow-up.

Results: GEE results showed a significant time x intervention effect on increases in HIV/STI knowledge, B = 4.83, SE = 1.23, p = .008, with women in SEPA increasing HIV/STI knowledge (Cohen’s d = .79) significantly more than women in the control group (d = .29). There was a significant time x intervention effect on change in consistent condom use with their main sexual partner, B = -1.04, SE = 0.35, p = .003, such that women in SEPA less likely to consistently use condoms over time (OR = 0.64), in comparison to control women who increased consistent condom use (OR = 1.77). There was no difference in change in the number of women with a main/regular sexual partner, B = 0.67, SE = 0.52, p = .194; nearly all women (88-93%) in both conditions reporting they had a main/regular partner at both times. However, there was a significant time x intervention effect on the number of sexual partners outside the main/regular relationship, B = -2.41, SE = 4.78, p = .047, with women SEPA having a greater reduction (d = .30) than controls (d = .23).

Conclusion: These results show mixed support for the effectiveness of SEPA over the initial six month follow-up period. It is not clear why women in SEPA increased their knowledge about HIV/STI prevention and risk, however showed a decrease in consistent use of condoms. Though, women in SEPA significantly reduced sexual contact with extra-relationship partners, which may have led them to be less concerned about using condoms with their main/regular sexual partner. It will be interesting, for future research, to assess the behavior of their main/regular sexual partners, to evaluate the level of riskiness of inconsistent condom use with these partners. Women in both conditions will be followed for an additional six months (i.e., one year post-baseline) to examine whether these patterns continue or change over time.