Cultural influences on HIV testing among Latino youth

Factors Associated with HIV Testing Among Spanish and English-Speaking Latino Adolescents Aged 13-18

Adolescent Latino men who have sex with men (LMSM) in the U.S. are disproportionately impacted by HIV. However, there has been limited focus on their HIV prevention and risk behaviors. In this study, we examine the rates of HIV testing and explore the significant demographic and healthcare factors that influence HIV prevention among adolescent LMSM. The analysis for this study utilized data collected during the baseline assessment of SMART, a pragmatic trial aimed at evaluating the effectiveness of an online HIV prevention intervention for adolescent LMSM (N = 524). Only 35.5% of participants had ever had an HIV test in their lifetime. Rates of testing increased among adolescent LMSM who had a doctor with whom they spoke about their sexual health (odds ratio: 4.0; 95% confidence interval: 2.1-8.4; P < 0.001) or HIV testing (odds ratio: 5.8; 95% confidence interval: 3.1-10.7; P < 0.001). Out of the 61 participants who took part in the survey conducted in Spanish, only 26% reported ever having an HIV test. Additionally, 24.5% stated that they had discussed their sexual orientation with a doctor, and only 8.2% had undergone HIV testing. Spanish-speaking adolescents who completed the SMART survey were less likely to openly discuss their sexual orientation or sexual health with most people or have a doctor with whom they discussed these topics, compared to those who completed the survey in English. These findings suggest that Spanish-speaking adolescent LMSM may face obstacles in accessing HIV prevention services in the U.S.

A review of bidimensional acculturation and STI/HIV-related sexual risk behaviours among Hispanic youth

A growing body of research suggests that acculturation may play a role in the disproportionate likelihood of sexual risk behaviour and STI/HIV infection among Hispanic youth in the USA. We systematically reviewed the relationship between acculturation and STI/HIV-related sexual risk behaviour among Hispanic youth aged 13-24 by reviewing studies that have used a bidimensional acculturation approach. Electronic databases were searched with the searches limited to articles published in 1992 when the concept of bidimensional acculturation was introduced or later. Two independent researchers screened the full data set to assess eligibility. Six studies were included. Three studies used cross-sectional data, while the other three used longitudinal data. We discovered that sexual risk behaviours differed by Hispanic youth acculturation types and were moderated by gender. We found that Hispanic acculturated youth had lower odds of having multiple sex partners than US acculturated youth. However, the relationship between acculturation and condom use yielded contradictory results and we could find no report on bi-culturation and sexual behaviour. Additional research is needed to explore whether adopting both US and Hispanic-heritage cultures at the same time may reduce or increase the odds of engaging in sexual risk behaviour among Hispanic youth in the USA.

Cultural interventions addressing disparities in the HIV prevention and treatment cascade among Black/African Americans: a scoping review

Culture is an important determinant of HIV risk and protective behaviors; yet, we know little about how it is integrated in HIV interventions. This scoping review characterizes the integration of culture in HIV prevention and treatment interventions focused on Black/African Americans. We searched MEDLINE, PsycINFO, CINAHL, and Google Scholar for peer-reviewed manuscripts published between July 1, 2011, and June 28, 2021. Twenty-five interventions were identified, with 96% focused on prevention. Most (40%) targeted men who have sex with men or transgender women. Only three were grounded in cultural theory. Although all interventions were labeled "culturally based," only two explicitly defined culture. Moreover, there was much diversity regarding the ways in which interventions integrated cultural elements, with some conflating race/ethnicity with culture. To improve uptake and HIV-related outcomes, interventions integrating culture are greatly needed. Additionally, HIV interventions purporting to be "culturally based" must include basic information to support rigor and reproducibility.

Barriers and facilitators to PrEP use and HIV testing for subgroups of Latino sexual minority men

Pre-exposure prophylaxis (PrEP) and HIV testing inadequately reach Latino sexual minority men (LSMM), fueling HIV disparities. This study identified determinants of LSMM's PrEP use and HIV testing and examined differences across subgroups (i.e., age and immigration history). First, we identified the most to least endorsed barriers and facilitators of PrEP use and HIV testing among LSMM (1) over vs. under 40 years old, and (2) across immigration histories (U.S. born, recent immigrant, established immigrant). Next, we examined differences in barrier/facilitator ratings across these age and immigration status groups. Key overall determinants were cost, knowledge, and perceived benefit/need. However, there was variation in determinants across age groups (i.e., cost, affordability, navigation support, and normalization) and immigration statuses (i.e., language, immigration concerns, and HIV knowledge). There were also differences across service types; mistrust and concerns was a barrier related to PrEP but not HIV testing. We found unique and common multilevel factors across prevention services and subgroups. Language, cost, and clinic/system issues are key barriers in accessing HIV prevention that should be considered when developing implementation strategies to enhance the reach of these services to LSMM.

A Hybrid Mobile Phone Feasibility Study Focusing on Latino Mothers, Fathers, and Grandmothers to Prevent Obesity in Preschoolers

OBJECTIVE

To pilot the feasibility of a mobile phone childhood obesity intervention for family caregivers of Latino preschool-aged children.

METHODS

An evidence-based early childhood obesity intervention was adapted to have cultural relevance and a shorter-length curriculum for mothers, fathers, and grandmothers of 2- to 5-year-old Latino children. Traditional in-person group sessions (four weeks) were combined with eight weeks of mobile phone content to support parenting skills and evidence-based and age-appropriate nutritional practices in either English or Spanish. A convenience sample of Latino families were recruited from WIC and Early Education Centers in East Los Angeles. Feasibility measures were collected. Child and caregiver height and weight were measured, and caregiver surveys of child dietary intake were collected at baseline, 1- and 6-month post-baseline. Changes in child's dietary intake and BMI, as well as caregiver BMI, were examined using a mixed effects linear regression model with family random intercept and nested random slope for time period of measurement.

RESULTS

The program was delivered to 64 low-income Latino families (46 mothers, 34 fathers, 16 grandmothers, and 48 children). Children had a reduction in raw BMI, BMI percentile, and BMI z-scores at 6-months post-baseline compared to baseline measurements. The study also demonstrated stable BMI outcomes among all caregivers.

CONCLUSION

The pilot study shows promise in preventing childhood obesity, and having a multi-generational impact on weight outcomes. Leveraging the high-use of mobile phones has the potential to shorten in-person interventions, and engage fathers and grandmothers who play an important role in shaping healthy weight practices in young children.

Assessing the Underestimation of HIV Risk Infection among Young Men Who Have Sex with Men in Argentina

The aim of this study is to describe the discordance between the self-perceived risk and actual risk of HIV among young men who have sex with men (YMSM) and its associated factors. An online, cross-sectional study was conducted with 405 men recruited from an Argentinian NGO in 2017. Risk discordance (RD) was defined as the expression of the underestimation of risk, that is, as a lower self-perception of HIV risk, as measured with the Perceived Risk of HIV Scale, than the current risk of HIV infection, as measured by the HIV Incidence Risk Index. Multivariate logistic regression models were used to analyze the associations between the RD and the explanatory variables. High HIV risk was detected in 251 (62%), while 106 (26.2%) showed high self-perceived risk. RD was found in 230 (56.8%) YMSM. The predictors that increased RD were consistent condom use with casual partners (aOR = 3.8 [CI 95:1.5-11.0]), the use of Growler to meet partners (aOR = 10.38 [CI 95:161-121.94]), frequenting gay bars (aOR = 1.9 [95% CI:1.1-3.5]) and using LSD (aOR = 5.44 [CI 95:1.32-30.29]). Underestimation of HIV risk in YMSM is associated with standard HIV risk behavior and modulated by psychosocial aspects. Thus, prevention campaigns aimed at YMSM should include these factors, even though clinical practice does not. Health professionals should reconsider adapting their instruments to measure the risk of HIV in YMSM. It is unknown what score should be used for targeting high-risk YMSM, so more research is needed to fill this gap. Further research is needed to assess what score should be used for targeting high-risk in YMSM.

Subjective culture and HIV preventive behaviour among young Latin Americans: a systematic review

Given high levels of new HIV infection globally, calls have been made for greater attention to the cultural variables that hinder prevention and testing. However, no reviews exist to systematise the findings. This study aimed to identify the cultural variables associated with three HIV preventive behaviours (condom use, HIV testing behaviour, and injection drug use with non-shared or sterilised syringes) among young Latin Americans. A systematic review was conducted guided by PRISMA-P criteria, on five databases (Web of Science, Scopus, PubMed, Medline and Scielo), which identified 2474 articles. Scientific articles and empirical studies that addressed cultural variables and HIV preventive behaviours among young people aged 15-24 years of age using Latin American samples were selected, with 37 articles being included in the final review. Six key cultural variables: the importance of female virginity; the role of trust in the couple's relationship; the disorienting effects of romantic love; the role of subjective norms; the importance of decision-making norms; and impulse control beliefs. Gender norms provide a framework for understanding sexual decision-making among young Latin Americans. Although young people have begun to adopt more egalitarian views of gender norms, deep-rooted beliefs about gender, sexuality and relationships continue to impact on HIV prevention behaviour.

HIV Testing Among Latino Emerging Adults: Examining Associations with Familism Support, Nativity, and Gender

Research examining factors associated with low uptake of HIV testing among Latino emerging adults is scarce. Thus, this study examined the association between familism support and lifetime history of HIV testing among Latino emerging adults, and whether nativity status and gender moderated this association. A cross-sectional online survey of 157 Latino emerging adults aged 18-25 years living in Arizona and Florida was conducted and data were analyzed using robust Poisson regression models. Results indicated that 59.9% of participants reported a lifetime history of HIV testing. Higher familism support was associated with a decreased prevalence of lifetime history of HIV testing (aPR  =  0.81, 95% CI: 0.68- 0.95). Nativity status moderated the association between familism support and lifetime history of HIV testing, with this negative association, only found among immigrants (aPR = 0.46, 95% CI: 0.28-0.74). Gender did not moderate this association. Familism support plays a role in HIV testing behaviors, and thus should be considered when developing programs to increase HIV testing among Latinos.

Culture and sexuality-related communication as sociocultural precursors of HPV vaccination among mother-daughter dyads of Mexican descent

U.S. Latinas are the second most affected ethnic group by cervical cancer morbidity and mortality. Cervical cancer is caused by high risk Human Papillomavirus (HPV) strains and HPV vaccines are an effective form of primary prevention. Parents are the primary decision makers of vaccination uptake as vaccination is recommended for children between the ages of 11–12. The purpose of our study is to investigate the influence of sociocultural factors particularly salient to U.S. Latinos and their role in facilitating or hindering communication about sexuality and vaccination uptake. We conducted a mixed methods sequential study with Latina mother-daughter dyads of Mexican descent (50% who had vaccinated). Our study was informed by the Information-Motivation-Behavioral Skills (IMB) model of preventive behavior. We assessed the influence of communication about sexuality on uptake and the influence of relationship factors such as familism, mother-daughter connectedness, and children’s autonomy and cultural factors such as acculturation and ethnic identity on sexuality-related communication. Our results indicated that mothers who engaged in conversations about birth control methods with their daughters had 5.69 times the odds of having vaccinated their daughters. Our qualitative data indicated that mothers who had vaccinated communicated about sexuality emphasizing that sexuality is a normal part of life, perceived that their child is likely to be sexually active one day, and viewed themselves as a primary source of sexuality-related information compared to mothers who had not vaccinated. Findings highlighted potential sociocultural approaches to motivate open communication about sexuality and adoption of sexual health preventative measures for children.

HIV Testing Among Heterosexual Hispanic Women in South Florida

PURPOSE

The purpose of this study was to examine the influence of selected facilitators, barriers, beliefs, and knowledge suggested by the literature to be associated with human immunodeficiency virus (HIV) testing among heterosexual Hispanic women.

DESIGN

This study utilizes a cross-sectional design to analyze secondary data from SEPA III: The Effectiveness Trial. SEPA stands for Salud, Educacion, Prevencion y Autocuidado, which translates to Health, Education, Prevention, and Self-Care. The Social Cognitive Model (SCM) guided this study.

METHODS

Three hundred twenty heterosexual Hispanic women 18 to 50 years of age participated in this study. Data were analyzed using descriptive statistics and logistic regression.

FINDINGS

The most common facilitators for HIV testing were receiving recommendations from a healthcare provider (HCP) and the test is offered by an HCP rather than women asking for it. The most common barrier to testing was having no reason to believe they were infected. Most women believed a positive test result would encourage them to take better care of themselves. However, as much as 15% of women reported desires to kill or hurt themselves if they test positive. On the other hand, a negative result would make them assume their partners are negative and thus do not need to be tested. Significantly, explanatory variables related to HIV testing were knowledge and the HIV test is offered by an HCP instead of women asking for it.

CONCLUSIONS

Strengthening HIV knowledge and offering HIV tests are significant contributions that nurses make to the health of Hispanic women. The SCM can be used to design programs to increase HIV testing among Hispanic women.

CLINICAL RELEVANCE

Nurses are encouraged to offer testing and provide culturally competent HIV prevention education to increase HIV testing among Hispanic women.

HIV Testing in Clinical and Community Settings for an International Sample of Latino Immigrants and Nonimmigrants

Latino/as in the U.S. and Spain make up a disproportionate percentage of cases of HIV infection, and often are diagnosed later than their non-Latino/a counterparts. Understanding the factors that affect HIV testing in different contexts is critical to best promote HIV testing, which is considered essential to both prevention and early treatment. This study explored differences in HIV testing rates among Latino/a participants in an international study designed to examine behavioral health screening for Latino/a populations. We collected data on testing rates and results from 407 Latino/as - both first generation immigrants and those of Latino/a descent - in the U.S. (Boston) and Spain (Madrid and Barcelona), through interviews conducted in community clinics and agencies. Using multivariate logit models, we evaluated predictors of screening and positive testing, adjusting for sex, age, and clinic type. HIV testing rates were highest in Boston, followed by Barcelona and Madrid (82%, 69%, and 59%, respectively, p < .0001). In multivariate regression models, Barcelona and Madrid patients were significantly less likely to have received testing than Boston patients. Significant positive predictors of HIV testing were: education level higher than high school, HIV concerns, infrequent condom use, other risk behaviors, reports of discrimination, and higher benzodiazepine consumption. Significant differences in HIV testing found in this study help to illuminate best practices for engaging patients in testing across sites.

LGBTQ+ Latinx young adults' health autonomy in resisting cultural stigma

Lesbian, gay, bisexual, transgender and queer/questioning (LGBTQ+) young people of colour are exposed to intersecting dynamics of social prejudice and discrimination related to sexuality and gender as well as race/ethnicity. In particular, Latinx-identifying LGBTQ+ young people face unique challenges in their lives, due to cultural stressors that stigmatise expansive gender and sexual identities. While it is crucial to examine the effects of multiple stressors on the well-being of LGBTQ+ young people of colour, this risk-based focus can overshadow the resilient capacities of multiply marginalised groups. Guided by an intersectional minority stress resilience framework, we asked: how do self-identified LGBTQ+ Latinx young adults manage cultural messages of prejudice and discrimination in relation to their health? Findings underscore how LGBTQ+ Latinx young adults established a strong sense of health autonomy to resist cultural stigma related to their intersecting identities. Young people actively educated themselves on health-related concerns, engaged in health-promoting tactics, and practised cultural negativity management to effectively navigate exposure to prejudice and discrimination.

A Critical Review and Commentary on the Challenges in Engaging HIV-Infected Latinos in the Continuum of HIV Care

Antiretroviral therapy for treatment of HIV infection has become increasingly effective. Persistent poor HIV outcomes in racial and ethnic minority populations in the US call for a closer examination into why Latinos are at significant risk for acquiring and dying from HIV. To improve clinical outcomes and achieve an AIDS-free generation, HIV research must address disparities in HIV outcomes in Latinos, the largest ethnic/racial minority population in the US. Immigrant status as well as cultural factors influence HIV care utilization and are essential to highlight for effective intervention development in Latinos. A better understanding of these individual and contextual factors is critical to developing tailored approaches to engaging Latinos in HIV care. Based on a comprehensive literature review, we offer a framework for understanding what is needed from clinical practice and research to improve engagement in HIV care for US-based Latinos. These findings may have implications for other minority populations.

Social networks, migration, and HIV testing among Latinos in a new immigrant destination: Insights from a qualitative study

Latinos in the U.S. are disproportionately affected by HIV and are more likely than non-Latinos to present with a late diagnosis, which delays engagement in HIV care and treatment. Social networks may provide normative influence and social support for HIV testing, but a contextualised understanding of networks is needed in order to maximise these social resources. We conducted qualitative interviews with foreign-born Latino men and transgender women (n = 17) in a new immigrant destination to explore their social networks. Most participants described having smaller social networks after migrating. Networks included both local and transnational ties, but most participants had few close ties. Contextual factors including stigma and geographic dispersion limited the re-construction of networks with close ties after migration. HIV testing was not a common topic of discussion with social network ties. Efforts to improve early uptake of HIV testing among Latino immigrants may benefit from engaging with social networks, but such efforts need to address how the context in which networks operate enables access to testing.