Efficacy of a Health Educator–Delivered HIV Prevention Intervention for Latina Women: A Randomized Controlled Trial

摘要

Objectives. We developed and assessed AMIGAS ( Amigas, Mujeres Latinas, Inform andonos, Gui andonos, y Apoy andonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally congruent HIV prevention intervention for Latina women adapted from SiSTA (Sistas Informing Sistas about Topics on AIDS), an intervention for African American women. Methods. We recruited 252 Latina women aged 18 to 35 years in Miami, Florida, in 2008 to 2009 and randomized them to the 4-session AMIGAS intervention or a 1-session health intervention. Participants completed audio computer-assisted self-interviews at baseline and follow-up. Results. Over the 6-month follow-up, AMIGAS participants reported more consistent condom use during the past 90 (adjusted odds ratio [AOR] = 4.81; P 1 Between 2000 and 2006, Latinos accounted for almost half of all US population growth, with nearly 40% of this increase attributed to foreign-born Latinos. 2 Latinos are also disproportionately affected by the HIV epidemic. 3 Between 2003 and 2006, more than half of Latinos diagnosed with HIV were foreign born, and the majority lived in the southern United States. 4 The Miami, Florida, metropolitan area has the highest rate of new AIDS diagnoses in the United States (42.8/100 000 population) 5 as well as a highly diverse Latino population. 6 Thus, HIV prevention efforts for Latinos in Miami must address this diversity. HIV diagnoses among Latina women (15/100 000) are 5 times the rate for White women, and annual HIV diagnoses have increased among foreign-born Latina women. 3 In addition to language barriers and lack of access to regular health care, adherence to traditional gender roles can increase foreign-born Latina women's vulnerability to HIV. 7 – 9 Widespread cultural values such as marianismo (Marianism), which stresses chastity before marriage and faithfulness, sexual passivity, and subservience after marriage, and s impatía , which stresses the importance of being agreeable and nonconfrontational in social relationships, can make negotiating and practicing safe sex challenging for Latina women. 10 , 11 Although Latina women are disproportionately affected by HIV/AIDS, they remain an understudied and underserved population. Recent meta-analyses reveal that few HIV sexual risk reduction interventions have demonstrated efficacy in decreasing HIV-associated behaviors among adult Latina women, 12 and available interventions do not address the cultural diversity of Latina women. 13 We developed AMIGAS ( Amigas, Mujeres Latinas, Informándonos, Guiándonos, y Apoyándonos contra el SIDA [friends, Latina women, informing each other, guiding each other, and supporting each other against AIDS]), a culturally appropriate adaptation of SiSTA (Sistas Informing Sistas about Topics on AIDS), a widely disseminated HIV risk-reduction intervention initially developed for African American women, 14 and assessed its efficacy in a randomized, controlled trial. AMIGAS was delivered by Latina health educators to a diverse, predominantly immigrant population of Latina women in the Miami metropolitan area.