Effects of a HIV Behavioral Prevention Intervention for Mexican and Puerto Rican Women : SEPA

1. Effects of a HIV Behavioral Prevention Intervention for Mexican and Puerto Rican Women: SEPA Nilda (Nena) Peragallo, RN, DrPH, FAAN Dean and Professor School of Nursing University of Miami

2. SEPA Project Salud/Health Educación/Education Prevención/Prevention Autocuidado/Self-Care Funded by NIH / NINR (P.I. Peragallo) R01 NR04746

3. Goal of the Study • Evaluate the effectiveness of a culturally specific intervention to prevent high-risk HIV sexual behaviors for inner city Latino women

4. Address Diverse Populations • Racial and ethnic minority populations are increasing in the United States. (In 2000, 32.8 million Latinos resided in the United States, representing 12.0 percent of the total U.S. population.) • As minority health care needs rise, so must the availability of services • Health care needs of minority populations are uniquely addressed by providers who are from the same minority group or individuals who are culturally competent with that particular groups.

5. Early Release of UN Report • AIDS cases accelerating worldwide • End of 2003 38 million cases • Up 10% over 2002 • Could be 45 million new infections by 2010 • Increased spending 300m to 5b • Only 1 in 5 people worldwide has access to AIDS prevention services All information from newest UN report, as featured in The Miami Herald July 7, 2004, more can be found at unaids.org

6. Women Catching up with Men • A generation ago, 1 in 10 of new AIDS patients in the US was a woman. Now it’s 1 in 4. • Worldwide women made up ~ 50% of adults living with HIV/AIDS in 2003, up from 41% in 1997 • In many societies women’s legal and social status is dependent to men’s and women may have little or no control over sexual behaviors of male partners and often cannot negotiate the use of condoms Reports from the International AIDS Conference, feature in The Miami Herald July 9, 2004

7. % Adult Women living with HIV/AIDS in 2003 • Global 48% • Sub-Saharan Africa 57% • Caribbean 49% • Latin America 36% • Eastern Europe 33% & Central Asia • South/SE Asia 29% • North America 25% • East Asia 22% From UN AIDS 2004 Report on Global AIDS, featured in The Miami Herald July 9, 2004

8. Need for Culturally Tailored Interventions Department of Health and Human Services, HIV/AIDS Surveillance Report 2002, Volume 14 U.S. Census Bureau, Statistical Abstract of the United States, 2003, Table 13

9. Cultural Tailoring • HIV/AIDS prevention for Latino women is urgently needed • Social learning theory and cultural specificity are critical for successful intervention • Socio-economic and cultural inequalities • Inequalities in personal and sexual relations • Psychological inequalities

10. Conceptual Framework Random Group Assignment Personal Factors Intervention Experiences Intermediate Outcomes HIV/AIDS Prevention Outcomes Relationship Factors

11. Research Design • Randomized pre-test/post-test comparison design and follow-up assessments at Baseline and 3 months • Facilitated by bilingual, bicultural, trained Latino women • 657 Sexually active Mexican and Puerto Rican women, aged 18 to 44

12. Randomized Groups Complete Intervention Offered to GROUP 2 Offered in a 2 day period (no payment) Voluntary Participation 3 6 Week 2 Week 3 Week 1 Week 4 Week 5 Week 6 6 GROUP 1 MONTHS MONTHS WEEKS (Intervention) $15 $15 $15 $15 $15 $15 *Interview 1 I n t e r v e n t i o n s * Interview 2 * Interview 3 * Interview 4 (Immediate Post) *HIV Pre-Test $20 $30 $40 Counseling $20 GROUP 2 3 6 6 (Control) MONTHS MONTHS WEEKS * Interview 1 * Interview 2 * Interview 3 * Interview 4 (Immediate Post) * HIV Pre-Test $20 $30 $40 Counseling $20

13. Intervention • Six weekly sessions, two hours • Know your own body • Skill training on condom use • Sexual communication and negotiation • Conflict management

14. Intervention (Cont.) • Violence prevention • Problem solving • Risk awareness • Risk management • Peer support for change efforts

15. Measures/Instruments

16. Bidimensional Acculturation for Hispanics HIV behavior knowledge Depression Self efficacy Substance Abuse Communication with partner Intimacy between partners Conflict management Conversations with male partners about condoms and HIV/AIDS concerns Condom use Outcomes Measurement

17. Data Collection & Sample • Data Collection: Feb. 1999 to Mar. 2001 • Sample Size:

18. SEPA participant engaged in session

19. SEPA group at one of the community sites

20. Analysis of Intervention Effects • Multiple Linear & Logistic Regression • Adjusted by Baseline score of each dependent variable, acculturation, ethnicity, poverty, insurance, lived with partner

21. Selected Outcomes • Condom Use • Health Protective Communication • HIV Knowledge • Risk Reduction Behavioral Intentions • Perceived Condom Use Barriers

22. Results (Cont.)

23. Results (Cont.)

24. Results (Cont.)

25. Participants presenting at last SEPA Intervention Session (2000)

26. Conclusions & Implications • Project SEPA was highly successful in increasing condom use, HIV health protective communication, and HIV knowledge and decreasing risk behaviors among low income, primarily Spanish speaking Latinas.

27. Conclusions & Implications • This study provided evidence that HIV/AIDS prevention interventions must be culturally tailored to the targeted population of the intended program.

28. SEPA group showing off diplomas