Pornography Use and Associated Factors in Adolescents: A Cross-Jurisdictional Approach (Spain vs. Mexico)

Pornography use is common among adolescents. However, there has been limited in-depth examination of cross-country differences in adolescent pornography use. Therefore, the main aim of the present study was to understand cross-jurisdictional differences in problematic pornography use (PPU) in 1810 adolescents from Spain and Mexico. The relationship between sociodemographic variables, loneliness, sexual risk behaviors, and religiosity with PPU and cross-jurisdictional differences between the two Spanish-speaking populations was assessed. In the Spanish sample, pornography use was a mediator of risky sexual behaviors, with this association being greater in males, older individuals, and those with a non-heterosexual orientation. In the Mexican sample, non-use of condoms was directly statistically predicted by older age, poor familial relationships, low religiosity, and more frequent pornography use. Jurisdictional differences in relationships between variables were observed in the two samples (Spanish and Mexican). Clinical implications and potential sociocultural factors that may underlie observed differences in the two Spanish-speaking cultures are considered and warrant additional investigation.

Relationship Factors Associated with Sexual Risk Behavior and High-Risk Alcohol Consumption Among Latino Men Who Have Sex with Men: Challenges and Opportunities to Intervene on HIV Risk

The HIV epidemic continues to be a major public health concern, affecting communities with varying prevention and treatment needs. In the U.S., Latino men who have sex with men (MSM) bear a disproportionate burden of HIV incidence. While recent studies have highlighted the relevance of relationship factors for HIV transmission among MSM generally, the unique needs and experiences of Latino MSM have received relatively little attention. Consequently, associations between relationship factors and HIV risk among Latino MSM remain unknown. This mixed-method study examined relationship status and dynamics and potential HIV-related risk behaviors among Latino MSM. Quantitative analyses with 240 Latino MSM investigated associations between relationship status and engagement in condomless anal intercourse (CAI). Focus groups with 20 Latino male couples and 10 health service providers explored the impact of relationship dynamics on sexual behaviors, as well as opportunities to intervene on HIV risk. The majority of participants were predominantly Spanish speaking, most screened positive for high-risk alcohol consumption in the past month, more than half engaged in CAI in the past 3 months, and a majority reported multiple sexual partners in this period. Among participants in same-sex relationships (n = 175), approximately half reported multiple partners in the previous 3 months and more than two-thirds reported CAI in this time period. Being in a same-sex relationship was positively associated with high-risk alcohol consumption and being age 30 or older and negatively associated with having multiple partners. Moreover, being in a same-sex relationship significantly increased the likelihood that participants would report engaging in CAI. Qualitative analyses identified themes related to relationship dynamics and sexual behavior, as well as opportunities to intervene on HIV risk. Despite the challenges encountered by Latino male couples, most participants expressed commitment to and support for their partners. As such, prevention efforts involving Latino male couples must address relationship dynamics and the role they play in sexual health, including safer sex practices.

Adaptation of a Couple-Based HIV/STI Prevention Intervention for Latino Men Who Have Sex With Men in New York City

Predominantly Spanish-speaking Latino men who have sex with men (MSM) and their same-sex partners continue to be at high risk for HIV and STIs. Behavioral research has identified how relationship dynamics for male couples are associated with sexual risk behavior. Connect 'n Unite (CNU), an evidence-based HIV/STI prevention intervention originally created for Black MSM and their same-sex partners, was adapted for predominantly Spanish-speaking Latino MSM and their same-sex partners on the assumption that its key elements would be translatable while its efficacy would be retained. A systematic adaptation process utilizing qualitative methods was used, including intervention adaptation sessions with 20 predominantly Spanish-speaking Latino gay couples and 10 health service providers. The process included five steps: (1) engaging community stakeholders, (2) capturing the lived experiences of Latino gay couples, (3) identifying intervention priorities, (4) integrating the original intervention's social cognitive theory into a relationship-oriented, ecological framework for Latino gay couples, and (5) adapting intervention activities and materials. The adapted intervention, which we called Latinos en Pareja or Latinos in a Relationship, incorporates elements that effective HIV prevention interventions share, including: a solid theoretical foundation; emphasis on increasing risk reduction norms, sexual communication skills and social support for protection; and guidance on how to utilize available, culturally and linguistically appropriate services. The systematic adaptation approach used for a couples-based HIV prevention intervention also can be employed by other researchers and community stakeholders to adapt evidence-based interventions that promote wellness, linkage to care, and disease prevention for populations not originally targeted.

Integration of Social, Cultural, and Biomedical Strategies into an Existing Couple-Based Behavioral HIV/STI Prevention Intervention: Voices of Latino Male Couples

INTRODUCTION

Successful HIV prevention and treatment requires evidence-based approaches that combine biomedical strategies with behavioral interventions that are socially and culturally appropriate for the population or community being prioritized. Although there has been a push for a combination approach, how best to integrate different strategies into existing behavioral HIV prevention interventions remains unclear. The need to develop effective combination approaches is of particular importance for men who have sex with men (MSM), who face a disproportionately high risk of HIV acquisition.

MATERIALS AND METHODS

We collaborated with Latino male couples and providers to adapt Connect 'n Unite, an evidence-based intervention for Black male couples, for Latino male couples. We conducted a series of three focus groups, each with two cohorts of couples, and one focus group with providers. A purposive stratified sample of 20 couples (N = 40, divided into two cohorts) and 10 providers provided insights into how to adapt and integrate social, cultural, and biomedical approaches in a couples-based HIV/AIDS behavioral intervention.

RESULTS

The majority (N = 37) of the couple participants had no prior knowledge of the following new biomedical strategies: non-occupational post-exposure prophylaxis (nPEP); pre-exposure prophylaxis (PrEP); and HIV self-testing kits. After they were introduced to these biomedical interventions, all participants expressed a need for information and empowerment through knowledge and awareness of these interventions. In particular, participants suggested that we provide PrEP and HIV self-testing kits by the middle or end of the intervention. Providers suggested a need to address behavioral, social and structural issues, such as language barriers; and the promotion of client-centered approaches to increase access to, adaptation of, and adherence to biomedical strategies. Corroborating what couple participants suggested, providers agreed that biomedical strategies should be offered after providing information about these tools. Regarding culturally sensitive and responsive approaches, participants identified stigma and discrimination associated with HIV and sexual identity as barriers to care, language barriers and documentation status as further barriers to care, the couple-based approach as ideal to health promotion, and the need to include family topics in the intervention.

DISCUSSION

We successfully adapted an evidence-based behavioral HIV prevention intervention for Latino male couples. The adapted intervention, called Conectando Latinos en Pareja, integrates social, cultural, behavioral and biomedical strategies to address the HIV epidemic among Latino MSM. The study highlights the promise regarding the feasibility of implementing a combination approach to HIV prevention in this population.

Adaptation and implementation of HoMBReS: a community-level, evidence-based HIV behavioral intervention for heterosexual Latino men in the midwestern United States

Over the past decade, the midwestern United States has witnessed a dramatic increase in its Latino population. The lack of culturally and linguistically congruent resources coupled with high incidence and prevalence rates of HIV among Latinos living in the Midwest merits attention. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables (Men Maintaining Wellbeing and Healthy Relationships) is a community-level social network intervention designed for Latino men. We describe the adaptation and implementation of HoMBReS for Latino men living in Indianapolis, Indiana, the second largest city in the Midwest. Five Navegantes (lay health educators) were trained; they provided a total of 34 educational charlas (small group didactic sessions). A total of 270 Latino men attended the charlas and were offered no-cost screening for HIV and sexually transmitted infections (STI). Three participants tested HIV positive and 15 screened positive for STI. The charlas coupled with the testing initiative, served as a successful method to increase sexual health knowledge among Latino men and to link newly-diagnosed HIV/STI-positive individuals to treatment and care. The adaptation and implementation of HoMBReS respond to the CDC and NIH call to increase HIV testing and service provision among vulnerable populations.

[A couple-based approach: An innovative effort to tackle HIV infection among Latino gay men.]

The HIV epidemic is a serious and pervasive health issue in the Latino community. While prevention efforts have helped maintain stability in the overall number of infections among Latinos for more than a decade, this population continues to be affected by HIV at high levels. In particular, Predominantly Spanish-speaking Latino men who have sex with men (MSM) are disproportionately impacted by HIV. Several factors contribute to the HIV epidemic among Predominantly Spanish-speaking Latino MSM including substance use; intimate partner violence; the presence of certain STIs; same-sex relationship dynamics; avoidance of seeking testing counseling and treatment out of fear of discrimination and immigration status; and poverty, migration patterns, and language barriers. In particular, epidemiological behavioral research has identified how relationship dynamics in male couples are associated with sexual risk behavior. Consequently, further research is needed to identify and deliver interventions geared toward couple-based risk reduction among men in same-sex relationships. This paper describes the potential significance that innovative couple-based approaches can have on reducing HIV and AIDS cases among Predominantly Spanish-speaking Latino MSM and their same-sex partners.