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Mano a Mano-Mujer: An Effective HIV Prevention Intervention for Chilean Women
Abstract
The impact of a professionally facilitated peer group intervention for HIV prevention among 400 low-income Chilean women was examined using a quasiexperimental design. At 3 months postintervention, the intervention group had higher HIV-related knowledge, more positive attitudes toward people living with HIV, fewer perceived condom use barriers, greater self- efficacy, higher HIV reduction behavioral intentions, more communication with partners about safer sex, and decreased depression symptoms. They did not, however, have increased condom use or self-esteem. More attention to gender barriers is needed. This intervention offers a model for reducing HIV for women in Chile and other Latin American countries.
... We analyzed 17 studies and 24 effect sizes regarding HIV knowledge (34,35,(74)(75)(76)(77)(78)(79)(80)(81)(82)(83)(84)(85)(86)(87)(88) (Figure 8). In 15 outcomes from 15 studies HIV knowledge of intervention receivers improved significantly compared to the control groups (34, 35, 74-81, 84-86, 88). ...
Background
Experiencing financial insecurity and being underserved is often associated with low health literacy, i.e., the ability to identify, obtain, interpret and act upon health information, which may result in poor health outcomes. Little is known about effective interventions for promoting health literacy among underserved populations. The objective of this systematic review is to summarize the literature on such interventions and identify characteristics that differentiate more effective interventions.
Methods
Following PRISMA guidelines we searched the databases SCOPUS, Pubmed, Web of Science core collection and CINAHL. We included primary studies with a quantitative study design and control groups testing interventions to increase health literacy or health knowledge in underserved populations between 18 and 65 years. Where possible, we converted effect sizes into Cohen’s d and compared mean differences of intervention and control groups. Albatross plots were created to summarize the results according to different health literacy and health knowledge outcomes.
Results
We screened 3,696 titles and abstracts and 206 full texts. In total, 86 articles were analyzed, of which 55 were summarized in seven albatross plots. The majority of the studies (n = 55) were conducted in the United States and had a randomized controlled study design (n = 44). More effective intervention approaches assessed needs of participants through focus group discussions prior to conducting the intervention, used bilingual educational materials, and included professionals fluent in the first languages of the study population as intervention deliverers. Additionally, the use of educational materials in video and text form, fotonovelas and interactive group education sessions with role playing exercises were observed to be effective.
Discussion
Although the outcomes addressed in the included studies were heterogeneous, effective intervention approaches were often culturally sensitive and developed tailored educational materials. Interventions aiming to promote health literacy in underserved populations should hence consider applying similar approaches.
Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=323801, PROSPERO registration ID: CRD42022323801.
... Posteriormente, se revisaron los planes de eliminación; las leyes y normas relacionadas con la transmisión maternoinfantil; notas periodísticas, y literatura científica, tanto de los países que han alcanzado la eliminación de ese problema de salud, como de aquellas naciones que han presentado mejoras notables en las Américas, con el fin de identificar mejores prácticas que pudieran replicarse en México. Se analizaron los siguientes países: Cuba, 19,20 Chile, [21][22] Argentina, 23 Brasil, [24][25][26][27] Uruguay, 28 El Salvador, 29,30 Nicaragua, 31 Panamá, [32][33][34] Estados Unidos, [35][36][37] Canadá, 38,39 Tailandia, 20,40 Bielorrusia 41-43 y los países del Caribe pertenecientes a la Asociación Pan Caribeña contra el VIH/Sida (PANCAP, por sus siglas en inglés). 44,45 Se seleccionaron las intervenciones que: a) tienen evidencia consistente sobre su eficacia, efectividad o eficiencia; b) muestran mayor fuerza de asociación en estudios observacionales, y c) son factibles de implementarse o adaptarse. ...
... As in Bandura's self-efficacy theory (1990,1995), the Self-efficacy for HIV prevention scale measures the participant's level of confidence in their ability to practice HIV preventative behaviors Seven items were rated on a 4-point Likert scale (1 = strongly disagree to 4 = strongly agree); total scores were calculated by adding the number of correct responses (Range = 7-28) to a higher score representing a higher level of self-efficacy for HIV prevention. The scale has been used previously with Latinas both in the United States (Peragallo et al. 2005) and internationally (Cianelli et al. 2012) in studies examining the efficacy of SEPA. The scale has been found to have a fairly low reliability of α = 0.68 (Peragallo et al. 2005). ...
Latina immigrant farmworkers are a vulnerable and understudied population that face a host of socio-cultural and structural barriers that place them at risk for HIV infection. Cultural factors, including traditional gender roles (egalitarian and marianismo) that frequently inhibit communication between partners and promote rigid roles, may particularly affect self-efficacy for HIV prevention among this population.
Objective: This study examines the impact of women’s gender norms on HIV knowledge and safe sex negotiation skills, along with the moderating influence of HIV self-efficacy among Latina immigrants in a farmworker community.
Design: The current cross-sectional analysis study examines data from a sample (N = 157) of mostly undocumented Latina immigrant farmworkers in South Miami-Dade County, Florida. Analysis was performed on secondary data obtained from baseline collected on an intervention pilot study. Measures of traditional American (egalitarian) and Latina (marianismo) gender norms, HIV self-efficacy, and HIV knowledge, as well as key demographic variables were collected.
Results: Findings revealed higher American (egalitarian) gender norms directly and indirectly predict higher HIV prevention factors. Additionally, HIV self-efficacy did not mediate effects of marianismo on HIV risk.
Conclusion: Findings conclude that HIV prevention can be especially challenging due to socio-cultural and traditional gender norms faced by Latinas in farm working communities and that such norms should be taken into account when developing and adapting culturally appropriate interventions to reduce HIV related risk behaviors for Latinas residing in urban or farm working communities.
... En consecuencia, estas valoraciones deberían ser priorizadas en futuras intervenciones basadas en la escuela, considerando que este es un espacio práctico y eficiente de formación en ssr para el establecimiento de hábitos saludables en esta área (40,41). Al mismo tiempo que pueden ser usados para la provisión de servicios de orientación y asesoría que fortalezcan habilidades para la negociación del uso del condón (42). ...
Introducción: caracterizar los conocimientos, actitudes, prácticas sexuales y procesos de comunicación familiar de hombres adolescentes de escuelas públicas y privadas, para visibilizar aspectos fundamentales en el abordaje de su salud sexual. Materiales y métodos: se realiza análisis descriptivo de datos correspondientes al subgrupo de hombres (n = 778) del estudio “Procesos de comunicación de sexualidad entre padres e hijos”, realizado durante 2012 en 23 instituciones educativas de Cali, Colombia, donde participaron 1225 adolescentes de ambos sexos. Se utilizó un cuestionario específicamente diseñado para el estudio, los datos se procesaron mediante el programa spss V.20 y se utilizó la prueba t-Student, el Análisis de Varianza anova y la prueba Chi-cuadrado, con un nivel de significación de 0.05 (5 %). Resultados: participaron 778 jóvenes entre 11-20 años de edad (media 15.3 años, DS = 1.6), de 12 instituciones públicas (n = 535) y 11 privadas (n = 123). Los jóvenes de instituciones privadas reportaron mayor acceso (p = 0.010) y recepción de información en sexualidad (p = 0.045). No se observó diferencia en edad de inicio de coito (media 13.2 años, DS 1.9) ni en no-uso sistemático del condón (p = 0.068), pero ambos grupos presentan di cultades en la comunicación en sexualidad con sus padres. Los estudiantes de instituciones públicas reportaron mayor frecuencia de prácticas sexuales anales (p = 0.002) sin uso adecuado de protección. Conclusión: el nivel de conocimiento de los jóvenes no se traduce en prácticas sexuales seguras, confirmándose la necesidad de diseñar programas con perspectiva de género que trasciendan la provisión de información y de crear acompañamientos que los empoderen en el autocuidado de su salud sexual.
... The total score was calculated by summing the number of correct responses (range ¼ 7-28) with a higher score representing a higher level of self-efficacy for HIV prevention. The scale has been used with Latinas in the United States ( Peragallo et al., 2005) and internationally ( Cianelli et al., 2012) in previous studies examining the efficacy of SEPA. The scale to been found to have a fairly low reliability of a ¼ 0.68 ( Peragallo et al., 2005). ...
Latina immigrants in the farmworker community are a vulnerable and understudied population at risk of acquiring HIV. Employing a CBPR framework, this pilot study was the first to evaluate the efficacy of SEPA, a CDC evidenced-based and culturally tailored HIV risk reduction intervention on a cohort of N = 110 predominantly undocumented Latina immigrants in a farmworker community. Findings revealed SEPA was effective in increasing HIV knowledge and decreasing HIV risk behaviors. However, no changes in self-efficacy were found in the present sample. We posit specific socio-cultural and structural barriers specific to the farmworker community not targeted in the original intervention may have hindered the program's capacity to influence changes in self-efficacy among this less acculturated population. Possible socio-cultural adaptations of the intervention to the target population and policy implications are discussed.
This study addresses rural Guatemala's poor maternal health and HIV status by culturally adapting an evidence-based HIV intervention, SEPA (Self-Care, Education, Prevention, Self-Care), to extend the capacity of comadronas (Mayan birth attendants) as HIV prevention providers. This mixed-method study examined the acceptability, suitability, and feasibility of SEPA presented to traditional elder and a younger cohort of comadronas over three sessions. Outcome variables were reported as mean scores. Open-ended qualitative responses were categorized under central themes. Session 1, 2, and 3 acceptability (4.6/5, 4.6/5, 4.8/5), suitability (4.7/5, 4.6/5, 4.9/5), and feasibility (4.4/5, 4.7/5, 4.8/5) remained high across sessions. While comadronas reported that information was difficult, they reported high levels of understanding and comfort with SEPA content and they also found it to be culturally appropriate, increasing their confidence to discuss HIV with their community. The broader utilization of comadronas could create a pathway to enhance reproductive health among indigenous women.
Objective:
The purpose of this meta-analysis was to examine the success of multiple-behavior interventions and to identify whether the efficacy of such programs depends on the number of recommendations prescribed and the type of outcomes measured.
Method:
We conducted a synthesis of 136 research reports (N = 59,330) using a robust variance estimate model (Tanner-Smith et al., 2016) to study change between baseline and the first follow-up across multiple-behavior interventions, single-behavior interventions, and passive controls.
Results:
Multiple-behavior interventions were more efficacious than their single-behavior counterparts (multiple-behaviors: d = .44 [95% confidence interval, CI [.27, .60]); single-behavior: d = .21 [95% CI [.00, .43]), with efficacy varying based on the type of outcomes measured. Publication bias analysis revealed a small asymmetry but controlling for it did not eliminate these effects. There was a strong linear relation between the number of recommendations prescribed by an intervention and intervention efficacy (B = .07, SE = .01, p < .001), with strongest improvements observed for interventions making five or more recommendations. These patterns remained when controlling for other intervention and population characteristics.
Conclusions:
Multiple-behavior interventions are successful in the HIV domain and increasing the number of recommendations made in the intervention generally maximizes improvements. These findings provide insights that may guide the design and implementation of integrated interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
In this study the author address rural Guatemala’s poor maternal health and HIV status by integrating an effective evidence-based HIV intervention (SEPA), with local implementing health partners to extend the capacity of comadronas (traditional Mayan birth attendants) to encompass HIV prevention. I employed a multi-method design consisting of a focus group, an interview, and participant observation to identify important factors surrounding comadrona receptivity towards expanding their capacity to HIV prevention. I analyzed data using thematic analysis and identified four categories: Project logistics, HIV knowledge and risk assessment, condom perceptions, and HIV testing perceptions. I affirm comadrona receptivity toward HIV prevention, and that will guide future cultural adaptation and tailoring of SEPA for comadrona training. I will use my results to create a prototype intervention that could be applied to other similarly underserved indigenous communities.
Introduction: Research is needed to identify influences on safe sex communication among specific culture groups. This study aimed to (1) describe sexual behaviors and indicators of sexual power among partnered Dominican women and (2) identify which of these indicators are significantly associated with safe sex communication. Methodology: Cross-sectional surveys, grounded in the theory of gender and power, were conducted with 100 partnered women at a clinic in southeastern Dominican Republic. Linear regression modeling was used to identify significant associations. Results: Self-efficacy (β = 0.48), total personal monthly income (β = 0.21), and history of sexually transmitted infection (β = 0.19) were significantly associated with higher level of partner safe sex communication. Discussion: Nurse clinicians, educators, and researchers should consider self-efficacy, personal income, and history of sexually transmitted infection when addressing communication in HIV prevention efforts among Dominican women.
Paternal involvement with children is associated with better outcomes for children and family functioning. There are, however, few data examining the intersection of cultural norms and paternal involvement. For Latino fathers in the United States, paternal involvement may vary on the basis of cultural and gender norms, acculturation process, and ethnic identity. The current study used self-report surveys to examine the perceptions of 67 Latino fathers regarding their paternal involvement, machismo (i.e., macho and caballerismo), degree of acculturation, and ethnic identity. The bivariate correlations revealed Latino fathers' Latino acculturation, and macho attitudes were significantly associated with paternal involvement, whereas ethnic identity and caballerismo attitudes were not. In the linear regression analysis, only Latino fathers' macho attitudes were negatively associated with paternal involvement after accounting for the variance in the other variables.
Much has been written concerning ethno-cultural constructs and their application to the behavioral health treatment of Latinas(os). Perhaps because of the inherent complexity of attempting to describe ethno-cultural beliefs and treatment implications while avoiding stereotyping and overgeneralizing, writings in this area often begin with brief descriptions of select cultural values. Often what follow are treatment implications and recommendations, embedded in a broader theoretical discussion. This article builds upon this work by placing cultural concepts in ecological perspective and offering practice recommendations that follow from specific cultural beliefs. Although not exhaustive, these recommendations are intended to offer concrete approaches to care that are consistent with a contextual understanding of individuals of Hispanic heritage, particularly of individuals of Puerto Rican ethnicity living in an urban setting. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
For the last 4 years we have implemented a model to mobilize rural health workers as leaders for HIV prevention in Malawi. We use a conceptual framework that integrates the World Health Organization's (WHO) primary health care (PHC) model, the social–cognitive model of behavioural change, and contextual tailoring of the intervention. Health workers are potential rural HIV prevention leaders because they have community trust and respect. However, their leadership potential has been limited by both health
system
barriers such as inadequate workers, supplies, and training and personal
barriers such as risky occupational and personal behaviours. In the first phase of the project, we developed collaborative relationships and conducted qualitative research to adapt a peer group intervention for rural health workers and community members. In the ongoing second phase, we trained the health workers, who then volunteered and provided the intervention to adults in the communities their health centres serve. The intervention was adapted for young people through a community participatory process. Currently the adapted intervention is being offered to young people. As a guide to replication, we discuss barriers encountered in implementing this collaborative project and how we overcame them. This project demonstrates that health workers can be effective leaders for community AIDS prevention in African countries. The primary health care model offers a feasible, cost-effective and sustainable approach to maximizing health worker-community collaboration to reduce the spread of HIV.
Given the significant upsurge in research on White males of European origin that documents a relationship between the construct of male gender identity (i.e., machismo) and physical and mental health, there is a clinical need to study and understand this construct and its relationship to health across diverse racial/ethnic groups, including, but not limited to, Hispanics. To help develop such understanding, this article first directs attention to a psychologically based gender schema theory that in the past 2 decades has received quite a bit of attention from researchers studying gender identity within the White majority populace. In focusing on this theory, the intention is to demonstrate how it can be used to provide a solid theoretical basefor clinical work with men whose social, mental, and physical well-being is negatively affected by their staunch adherence to a rigid traditional male gender identity. Specific recommendations that both researchers and clinical practitioners might take into consideration vis-a-vis this construct in their respective work are presented.
The incipient HIV/AIDS epidemic in Chile poses challenges for responsiveness of the Chilean national health care system, Fondo Nacional de Salud (FONASA) (National Health Funds), especially given the sociocultural forces for inertia in FONASA. Thus, the issue is what is the nature of the forces for change. A grounded theory approach was applied to interview data from two qualitative studies, one with HIV/AIDS advocates and activists as interviewees and the other with Chilean low-income women. The stories of their experiences with and perceptions of FONASA revealed major issues facing FONASA, including quality of care and ethics. Ways in which these issues are being addressed by the activists result in constructed environmental dynamism. A conceptual model of the forces for change was developed including actors, strategies, and targets of change that constitutes organizational environmental dynamism. The construct of environmental dynamism has international applicability, particularly to governmental health systems, which are influenced by strong sociocultural forces.
Although there is a growing body of literature reporting the results of evidence-based HIV prevention programs, few include a plan for effectively translating their findings into clinical practice. The numbers of HIV/AIDS cases among minority women have been increasing at a rate significant enough to confirm the need for prevention programs. Moreover, the importance of translating research into clinical practice has been well documented in medicine and nursing. The goal of this article is to increase the understanding and endorse the importance of translating evidence-based HIV prevention programs into practice. Key characteristics and a model for supporting the translation of HIV prevention programs will be presented, specifically for minority women. To significantly improve the direction of addressing HIV/AIDS infection among minority women, substantial changes are required; this includes the translation of evidence-based HIV prevention programs into practice.
Background and Objectives:: To examine prevalence and predictors of condom use and human immunodeficiency virus (HIV) test seeking among women living in inner‐city housing developments.
Study Design:: Between April and June 1994, 671 women living in low‐income housing developments in five cities in the United States completed an anonymous self‐report questionnaire eliciting information on acquired immune deficiency syndrome (AIDS) risk behavior and characteristics indicative of risk.
Results:: Most participants were women of color who were economically disadvantaged. Fifteen percent reported multiple sex partners, and 30% of women with one sex partner believed he had sex with someone else in the past year. Predictors of condom use included increased rates of safe‐sex negotiation, stronger risk reduction intentions, absence of condom barrier beliefs, and multiple sex partners. Women tested for HIV in the past year were younger, perceived themselves to be at risk for HIV infection, reported more conversations with other women about AIDS concerns, and had condoms readily available.
Conclusions:: HIV public health prevention interventions are urgently needed for women who live in low‐income urban housing developments.