Objective: The goal of this study was to evaluate the effectiveness of a theoretically based, HIV risk reduction intervention led by Latinas, and tailored to the specific needs of low income Latinas.
Design: Project SEPA (Salud, Educacion, Prevencion y Autocuidado; Health, Education, Prevention and Self-Care), a culturally tailored HIV risk reduction intervention prevention program targeting low-income Latino women, was evaluated using a randomized pre-test/post-test comparison design and follow-up assessments.
Population, Sample, Setting, Years: In Chicago, IL, USA, 657 Latina women aged 18 to 40, who reported sexual activity during the past three months were recruited with a variety of methods, including flyers in English and Spanish placed at community agencies partnering with us, grocery stores, Laundromats, public announcements were broadcasted in the Mexican and Puerto Rican radio stations, and free ads appeared in the free Latino newspaper “EXITO”. The data collection started February 1999 and was completed in March 2001.
Methods: Women were randomly assigned to either an intervention or control group. Both groups were assessed at baseline, 6-week, 3-month and 6-month post intervention. The HIV risk reduction intervention consisted of the six weekly sessions, two hours long, which included: skills training on condom use, sexual communication and negotiation, conflict management and violence prevention, problem solving, risk awareness and risk management, and peer support for change efforts. Specifically, the issue of unequal power based on the cultural value placed upon “Machismo” and “Marianismo”, including the importance of motherhood, is directly addressed, and an entire session was developed and tested dealing with conflict management and prevention of violence to address potential problems in the relationships of Latinas.
Findings: Women in this sample had low acculturation levels; 75% of the interviews were in Spanish. 81% lived with partners and 65% had fewer than 2 lifetime partners. At the 3 month and 6 month follow-up, the intervention group were more likely to use condoms more than half the time with all types of sexual activity adjusted odds ratios and 95% confidence interval of 2.405 (1.404, 4.120) and OR, 95% CI: 1.609 (1.000, 2.617), respectively. HIV knowledge, behaviors and attitudes also showed differences between intervention and control at the 3 and 6 month points. At 3 months and 6 months respectively, the intervention group had higher knowledge than the control groups: difference scores and 95% CI around those differences are 2.755 (2.364, 3.1460) for the 3 month and 2.136 (1.750, 2.522) for the 6 month. For "health protective communication" where higher scores are better, the intervention group had higher scores at 3 months 2.277 (1.594, 2.960) and 6 months 1.124 (.424, 1.825). For "risk reduction behavioral intentions" where higher scores are better, the intervention group had higher scores at 3 months 1.425 (.835, 2.015) and 6 months 0.732 (.183, 1.281). For "perceived condom use barriers" where higher scores are better, the intervention group had higher scores at 3 months 1.729 (1.121, 2.337) and 6 months 1.149 (.551, 1.748).
Conclusions: Project SEPA was highly successful in increasing HIV knowledge and decreasing risk behaviors among low income, primarily Spanish speaking Latinas.
Implications: HIV/AIDS prevention interventions must be culturally tailored to the target population of the intended program. In the Latino culture, women show deference and respect to their health care providers and it is not socially acceptable to question their information and/or authority. As a result, these women may respond that they understand their health care provider instructions and explanations, when in fact they do not. In order to give better culturally appropriate and sensitive treatment, health care providers must to assess the women’s cultural, educational, and health knowledge background. It is recommended that Project SEPA be replicated with similar populations.
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