Adaptation and PilotTesting of SEPA Intervention for Hispanic Women and Men in South Florida

Thursday, 19 July 2018: 2:50 PM

Nilda (Nena) Peragallo Montano, DrPH, RN, FAAN
Schol of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Rosina Cianelli, PhD, MPH, RN, FAAN, IBCLC
Schol of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA
Natalia Villegas, PhD, MSN, RN, IBCLC
School of Nursing and Health Studies, University of Miami, Coral Gables, FL, USA

Purpose: In the United States, the incidence of HIV is increasing more rapidly among racial and ethnic minorities, who represent more than 72% of new HIV cases and 68% of those currently living with HIV. Hispanics comprise about 24% of Florida’s total adult population, and they account for 21% of all people living with HIV and 17% of AIDS cases. Miami-Dade and Broward counties have the highest numbers of AIDS cases statewide. Few intervention research studies have sufficiently large Hispanic sub-samples to evaluate the efficacy of interventions for Hispanics. Despite statistical trends documenting the growing spread of HIV infection among Hispanic women and men, no HIV/AIDS prevention programs tailored to the needs of both are available. Men and their partners are vulnerable to acquire HIV because of male risky sexual behaviors as well as drug and alcohol use. Community based programs are needed that are both culturally appropriate and accessible for Hispanic women and men. The purpose of the proposed study is to adapt and pilot test the SEPA intervention for HIV prevention among Hispanic Men and Women between 18 and 50 years old.

Methods: A mixed methodology (quantitative and qualitative) design was used to collect information about HIV risk factors and preferences to adapt SEPA intervention to Hispanic men and women needs. The sample consisted of 71 Hispanic men and women between 18 and 50 years old, English or Spanish speaking, sexually active in the last 3 months. All 71 participants completed a quantitative survey to assess their risk factors and preferences to learn about HIV. In addition, 21 of them participated in focus groups to determine methods to implement SEPA based on their preferences and to determine the feasibility of delivering the SEPA intervention for Hispanic men and women together in the group sessions. Finally, 5 participants were part of the pilot of the adapted SEPA intervention. SEPA is based on input from Hispanic women, Bandura's Social Cognitive Theory, and Freire’s Pedagogy of the Oppressed. The Predictive Analytics SoftWare (SPSS) was used for data analysis. Descriptive and inferential statistics were used to analyze quantitative information. Content analysis was used to identify and define the major themes that emerged from the focus groups.

Results: Thirty six (50.7%) participants were Hispanic men and Thirty five (49.3%) were Hispanic women. The language of preference was Spanish (n=55, 77.5%). More than a third (n=28; 39.4%) were in a relationship, 22 (31%) were married, 16 (22.5%) were single, and 5 were divorced (7%). The average number of children was 2.01 ± 1.9 (range= 0-7). In relation to the country of origin, the majority were from Mexico (n=28, 39.4%), followed by United States (n=15; 21.1%), Guatemala (n=12, 16.9%), El Salvador (n=5, 7 %), Colombia (n=4, 5.6%), and other countries from Latin America (n=7, 9.8%).The average education was 10.34 ± 4.2 years and the majority were working (n=38, 53.5%).
In relation to HIV risk, almost half (n=30, 42.3%) of the participants did not feel at risk of acquiring HIV and the majority of them (n=56, 78.9%) were tested for HIV before the study. Hispanic women had an average of 8.63 ± 29.9 lifetime sexual partners, and 1.03 ± .17 in the last 6 months. Condom use among Hispanic women with a stable partner was low, with only 11 (31.42%) of women using condoms half or less than a half of the time and 15 (42.9%) women never used them in the last 6 months. Hispanic men had higher risk behaviors, with an average of 23.80 ± 51.9 lifetime partners and 2 ± 3.2 sexual partners in the last 6 months. Condom use was even lower among Hispanic men, with only one man (2.8%) reporting that it was always use. The majority (83.3%) reported never used a condom and 2 less than half of the time (5.6%).
The qualitative results revealed that Hispanic men and women are at high risk of acquiring HIV and that there is a lack of interventions tailored to them. Hispanic men and women said that they would feel comfortable sharing SEPA intervention sessions with other men and women but only if their partners were not on the same group. Participants found the intervention feasible and acceptable.

Conclusion: Culturally-specific interventions have promise in preventing HIV for Hispanic women and men in the U.S. SEPA should be disseminated to community-based organizations for wide-scale use.