Posts classified under: People of Color (POC)

Assessing Sexual Social Networks of Black and Hispanic MSM/Ws in Los Angeles County

Nationally and locally Blacks and Latinos have the highest incidences of HIV/AIDS. When stratifying incidence by gender, Blacks and Latino women have higher rates of HIV infection compared to their White counterparts. A recent “mainstream” hypothesis for the rise in numbers among minority women is that Black and Latino men in concurrent secret sexual relationships with men and Black and Latina women are the “bridgers” of infection between the homosexual (MSM) community and the heterosexual community. Currently no scientific evidence of transmission trends supporting this hypothesis has been documented. Although inferences from surveys such as the Young Men’s Study have been proffered as proof, such studies do not show direct causation. Further, few scientific studies have analyzed the societal and cultural factors that could impact the decision of Black and Latino men to disclose their sexual practices or HIV seropositivity.

The research project involved a two phase mixed methods study (qualitative and quantitative) focusing on cultural, spiritual, racial and gender related factors that facilitate or impede the disclosure of Black and Latino men who have sex with men and women (MSM/W) of their sexual preference or HIV serostatus.

Phase 1 consisted of 9 focus groups with 4 participants each (n=36) and 12 focused interviews (n= 12). All interviewees completed a short survey after the focus group or interview. A racially concordant facilitator conducted each research session. Phase 2 utilized findings from Phase I to construct an ethnographic interview guide. Forty ethnographic interviews (10 African-American MSM/W, 10 Hispanic MSM/W and 20 of their adjacent or peripheral female sexual partners) were conducted.

Evaluating Locally Developed “Homegrown” HIV Prevention Interventions for African American and Hispanic/Latino MSM

Funded by the Centers for Disease Control and Prevention (CDC), this project is a collaboration between In The Meantime Men’s Group, Inc. (ITMT) and Los Angeles County Department of Public Health HIV Epidemiology Program. The objectives of the project are to recruit and enroll 530 African American MSM, ages 18-29 years, for a randomized controlled trial (RCT) to test the efficacy of the MyLife MyStyle group-level, HIV prevention intervention to reduce unprotected anal sex among intervention participants over a six-month follow-up period. Specific activities required to evaluate the RCT include development of a program theory/logic model, refinement of the “home-grown” intervention curriculum, process evaluation of participant enrollment and retention, fidelity monitoring of the intervention facilitator to the MyLife MyStyle curriculum, development of quantitative and qualitative instruments, and evaluation of program outcomes at three and six month follow-up assessments.

This project is currently in progress. The assessments, curriculum, protocol, are project documents being prepared for CDC review. They are not available for release. Dr. Rosemary Veniegas of CHIPTS serves as the Evaluation Consultant on the project.

P-QUAD Study

PQUAD is a pilot project to evaluate the acceptability, safety, and feasibility of delivering community-based HIV post-exposure prophylaxis in diverse Los Angeles County communities. It is a joint venture of UCLA, the Los Angeles Office of AIDS Programs and Policy (OAPP), the Department of Public Health Sexually Transmitted Disease Program, AIDS Project Los Angeles (APLA), and pharmaceutical industry partners.

Originally conceived in December, 2007, P-QUAD is now operational at 2 sites in epicenters of the HIV epidemic in Los Angeles: The Los Angeles Gay and Lesbian Center (opened March 2, 2010 in the Hollywood/West Hollywood area of Los Angeles with a largely MSM catchment), and The OASIS Clinic (opened April 15, 2010 in the south central area of Los Angeles with a largely lower socioeconomic status, at risk African-American and Latino catchment). The study provides dual or triple-agent ART for 28 days as post-exposure prophylaxis for HIV infection to individuals exposed sexually or via injection-drug works sharing, when presenting within 72 hours of an appropriately high-risk exposure. Additionally, substance use, mental health, and behavioral risk reduction referrals/linkages are provided as appropriate. Efficacy, safety, adherence, tolerability and behavioral outcomes are being collected. In the event of seroconversions, longitudinal specimens are stored for virologic analyses.

The program currently is providing Truvada (tenofovir + emtricitabine), or Combivir (zidovudine + lamivudine) with or without Kaletra (ritonavir + lopinavir). An upcoming amendment will offer Isentress (raltegravir) as an alternative to Kaletra for intolerance. An IND has been filed with the FDA for the use of these agents in a non-FDA approved study context (IND # 104,989) and the study is overseen and all study documents approved by the UCLA Institutional Review Board. Since opening the program, the P-QUAD has enrolled 30 participants as of May 6, 2010 [29 at LAGLC and 1 at OASIS], with an initially planned enrollment of 100 participants (50 at each site).

Feasibility Study of a Community Level, Multi-Component, Intervention for Black MSM

To ascertain the feasibility and acceptability of an intervention among Black men who have sex with men (MSM), to prepare for a community-level randomized trial to test the efficacy of the intervention in reducing HIV incidence among Black MSM.

Approximately 2136 “first wave” participants (267 per site at eight sites) and approximately 400 referred partners (70 per site at six sites). There will be no limit on enrollment of participants referred by “index” participants already in the study (according to the referring scheme in the protocol). Index participants are defined later in the protocol, but can be generally described as those newly identified with HIV infection, those with previously diagnosed HIV infection who are not receiving HIV care, and certain HIV negative participants. Men enrolling for this study who have not been referred by an index participant will be called “first wave” participants. Enrollment of first wave participants will cease when 200 first wave participants eligible for longitudinal follow up have been enrolled. Enrollment of certain sub-categories of first wave participants will be limited according to criteria detailed in the protocol.

Treatment Regimen:

The intervention components provided to participants include: HIV risk-reduction counseling, testing and referral for care STI testing and referral for care Screening for substance use and mental health issues, and provision of counseling and referral for care (if indicated) Engagement with peer-health navigators to facilitate uptake of healthcare and other services Enumeration of up to 20 social and sexual network members by all participants and referral of up to 5 sexual partners by index participants for enrollment into the study

Primary Objectives:

To obtain information needed to design the full community-randomized trial, particularly in the areas of: recruitment of black MSM satisfaction of Black MSM with intervention components uptake of the intervention components by Black MSM, including: Proportion of enrolled participants who agree to HIV testing Proportion of participants who agree to STI testing Proportion of participants who utilize peer navigator referrals Proportion of HIV infected participants entering HIV care Increase in condom use in all participants from enrollment to week 52 Decrease in viral load among HIV infected participants from initiation of HAART to week 52 Decrease in STIs among all participants from enrollment to week 52

Secondary Objectives:

To collect samples, behavioral data and HIV test results to improve laboratory measures of HIV incidence based on samples derived from cross-sectional studies To estimate the HIV incidence rate and the effect of the intervention on the incidence rate through mathematical modeling To describe characteristics of sexual network members of black MSM who are newly diagnosed with HIV infection, or previously diagnosed but not in care To assess attitudes of black MSM toward other prevention interventions To describe social and sexual networks of Black MSM within cities to inform decisions about what constitutes a randomizable unit for a future trial of the intervention.

Study Sites:
• Atlanta: Emory University
• Boston: Fenway Community Health Center
• Los Angeles: University of California Los Angeles
• New York City: New York Blood Center/Harlem Hospital
• San Francisco: San Francisco Department of Public Health
• Washington DC: George Washington University

Interventions, Training Manuals, etc. :
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¡Tu Vales!: An HIV Testing Campaign for Latino Day Laborers

Project Name: 

¡Tu Vales!:  An HIV Testing Campaign for Latino Day Laborers

Some Latino men involved in high risk behaviors have been found to be more likely to choose to get tested for HIV when the HIV test is “bundled” with other tests.

A recent study of Latino male immigrant day labors in Los Angeles County found that engaging in risk behaviors, such as having sex with men, was not associated with HIV testing. Thus some day laborers at high risk may not be accessing HIV testing services. However, increasing HIV testing among Latino day laborers may not solely be a function of offering the HIV test to them. Unique ways of offering HIV testing may be required in order to increase HIV testing. Some Latino men involved in high risk behaviors have been found to be more likely to choose to get tested for HIV when the HIV test is “bundled” with other tests compared to when it is offered by itself. The objective of this study is to increase HIV testing among day laborers at risk for HIV. The specific aims of this study are:

(1) to determine if a “bundled” HIV testing protocol directed at day laborers results in more immigrants accessing HIV testing compared to an HIV-only testing protocol., and

(2) to determine if a “bundled” HIV testing protocol results in more men engaging in HIV prevention services among those involved in high-risk activities compared to when an HIV-only testing protocol is used.

The “bundled” HIV testing protocol will include tests or screeners for syphilis, gonorrhea, chlamydia, alcohol problems, drug dependence, depression and HIV. Individuals in the HIV-bundled protocol will be able to choose to be tested for all conditions or just some of them.

Targeted Risk Group: 

Latino day laborers engaged in high-risk activities

Research Methods: 

In contrast to previous studies with day laborers, this study will involve a random recruitment of day laborers using a spatial-temporal sampling frame. Two HIV testing protocols, one “bundled” and the other “HIV-only,” will be carried out at day labor sites in Los Angeles County. In the formative stage of our project, we plan to determine which day labor sites contain the largest number of day laborers reporting high-risk activities. We will use the Service Planning Areas (SPAs) of Los Angeles County. We will utilize SPAs 4, 6, 7 and 8. By doing so, we will be focusing on the areas in which 73.9% of all male Latino HIV/AIDS cases were identified between 2004 and 2007. Once all day labor sites in these SPAs are identified, we will visit them at randomly selected times and randomly sample 15% of the individuals who are present when we arrive. These participants will be administered a short screener to assess HIV-related high-risk behaviors. After determining which sites contain the largest number of day laborers reporting high-risk activities, we will develop a sampling unit of “site-day-shift,” where “site” refers to the day labor site, “day” to the day of the week, and “shift” to a 5-hour time period within the day. The sampling plan for the study recruitment for the main part of the study will involve 4 stages: the random assignment of the 4 SPAs to either the HIV-only protocol or the HIV-bundled protocol, the monthly random selection of the day labor sites, the monthly random selection of the sampling units and the random selection of participants at the day labor sites.

A total of 800 participants will be recruited, with one-half being recruited through the HIV-testing only protocol and the other half through the HIV-bundled protocol. Tallies will be kept of the number of people who are approached and asked to participate for each testing protocol and those who accept and decline HIV testing. Rates of HIV testing for the two HIV testing protocols will then be compared.

This study is interested also in which protocol results in greater engagement in HIV prevention services among those reporting high-risk activities. Those reporting HIV-related high risk behaviors will be contacted 2 months later for a brief phone interview to determine if they subsequently utilized the referrals to HIV prevention programs. The two HIV testing protocols will then be compared to determine which resulted in a greater use of HIV prevention services by day laborers.

Local significance:

Information on potential increased HIV testing by day laborers using a “bundled” testing protocol would contribute to advancing HIV prevention science and also provide important information for prevention programs throughout California. Thus, this project is very attentive to the needs of public health and community based organizations in California attempting to counter the present trend of late testing among Latinos.

HIV Prevention Capacity Building Assistance and Technical Assistance for Community-Based Organizations and Health Departments

This CDC-funded project is a collaboration between AIDS Project Los Angeles (APLA) and CHIPTS aimed to deliver capacity building assistance (CBA) services to community based organizations (CBOs) and health departments in the areas of (1) organizational infrastructure and program sustainability, (2) evidence based interventions and public health strategies, and (3) monitoring and evaluation.

The project will provide a wide range of CBA services to CBOs, including individually-tailored CBA (ICBA) services to address specific HIV prevention programmatic needs for organizations serving racial and ethnic minority communities and other high risk populations. The project will conduct an individual CBA needs assessment as the foundation of ICBA services, through which we will jointly develop an action plan with the CBO to address identified needs.

ICBA services may include: individualized technical assistance and consultation; skills building trainings (both inperson and web-based formats); web seminars; information transfer and technology transfer through the broad dissemination of technical information; participation in an online discussion forum to promote peer-to-peer sharing of best practices; and promotion of program collaboration and service integration across public health initiatives. In addition, the project will implement similar CBA services to health departments as it does to CBOs. However, we will tailor information and materials, skills building trainings, web seminars, etc. to address the unique needs and problems of health departments. The project will also work closely with health departments to provide training in the evaluation of community planning methodologies. We also propose to collaborate with other CBA providers to develop a Professional Development Certificate Program for health department staff, ensuring a basic level of knowledge across all four component areas.

For more information, please visit the Shared Action website at www.sharedaction.org.

Together Learning Choices (TLC)

TLC (Together Learning Choices) is an HIV prevention and health promotion intervention developed for HIV-positive teens and youth (ages 13 to 29). TLC is delivered in small groups using cognitive-behavioral strategies to change behavior. It provides young people living with HIV the tools and skills necessary to live their best lives and to be able to make healthy choices. The goal of the intervention is to help these young people maintain health, reduce transmission of HIV and infectious diseases, and improve their quality of life. TLC is a product of extensive collaboration among researchers, staff from public and private agencies serving the population, and members of the intended population, representing diverse backgrounds and perspectives.

TLC consists of two sequential modules that totaled 16 sessions. Each module has eight sessions and is designed to be delivered by two Facilitators in a group setting.

  •  The Staying Healthy module encourages healthy living by focusing on health maintenance and forging effective partnerships with health care providers.
  • The Acting Safe module is dedicated to primary and secondary HIV prevention by addressing sex- and substance use-related risk behaviors and reducing new infections and reinfections.

– The goal of this study was to design, pilot test, and evaluate an intervention for service providers to address HIV-related stigma and its impact on health service delivery and adequate care.
TLC is a science-based behavioral intervention that has demonstrated evidence of effectiveness in reducing risky behaviors, such as unprotected sex, or in encouraging safer ones, such as using condoms and other methods of practicing safer sex. It is offered by the Centers for Disease Control and Prevention (CDC) through the Replicating Effective Programs (REP) and Dissemination of Effective Behavioral Interventions (DEBI) at www.effectiveinterventions.org.

Targeted Risk Group:
Young People Living with HIV (YPLH) aged 13 to 24 in original efficacy trial and aged 13-29 in . The majority of participants were African-American and Latino.

Intervention model:
Small group intervention.
Original intervention manuals available here:

Module 1 – Staying Healthy

CDC funded replication manual: TLC Implementation Manual
TLC Broadsheet

Research Methods:
Group randomized trial with immediate intervention and delayed (waitlisted) control conditions. Assessment interviews conducted every three months over 24 months.

Local Significance:
The intervention reduced sexual risk behaviors, substance use, and emotional distress, and increased social support and other positive coping styles.

Teens and Adults Learning to Communicate (TALC: NYC)

Teens and Adults Learning to Communicate

Project TALC was funded by the National Institute of Mental Health (NIMH) and is an intervention designed to improve behavior and mental health outcomes among parents with AIDS and their adolescent children. The study sample was comprised of 307 financially-needy, AIDS-infected parents in New York City and 412 adolescent children. The majority (80%) of the parents were mothers. Approximately one-half of the study participants were Latino and over one-third were African American.

Targeted Risk Group: 

AIDS-infected parents and their children

 Intervention model:

Cognitive behavioral intervention comprised of two modules. The first module was for parents only (8 sessions) and focused on coping with the HIV illness and disclosure. The second module was for parents and their adolescents (16 sessions) and focused on ways to plan a legacy, e.g. making custody arrangements.

 Research Methods: 

In a random assignment study, families assigned to take part in Project TALC were compared with families assigned to a control group on mental health and health behaviors, including sexual behavior and substance use. Because participants were followed over time, longitudinal random effect regression models were used to test the efficacy of the intervention.

 Local Significance: 

Over the two-year follow-up period, adolescents assigned to take part in the intervention reported significantly and substantially lower levels of emotional distress, conduct problems, and family-related stressors and higher levels of self-esteem than did control group adolescents.

 International Significance: 

Project TALC provided a behavioral intervention that can be adapted for other countries and cultures to improve behavior and mental health outcomes among parents with AIDS and their adolescent children.

Published Journal Articles:

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Please see TALC LA for the up-to-date intervention manuals.

Surveys and Scales Used: 

  1. Needle Use and Sharing - Survey
  2. Acculturation, Habits, and Interests Multicultural Scale for Adolescents (AHIMSA)
  3. Medication Adherence - Survey
  4. Self Harm: Suicide History - Survey
  5. CDC Sexual Behavior Questions (CSBQ)
  6. Health Belief Model: Self-Efficacy for Sexual Discussion (HBMSD) - Scale
  7. Self-Efficacy to Refuse Sexual Behavior (RSB) - Scale
  8. Self-Efficacy for Limiting Substance Use - Scale
  9. Self-Efficacy for Negotiating Condom Use - Scale
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  11. Detention and Jail History Assessment - Survey
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  13. Alcohol and Other Drug Abuse (AOD) - Scale
  14. Dealing with Illness - Scale
  15. Rosenberg Self-Esteem (RSE) - Scale
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  17. Parker Parental Bonding Instrument
  18. Network Assessment
  19. Life Events Assessment - Survey
  20. HIV Related Incidents - Survey
  21. Healthcare Utilization, Providers, and General Health Assessment: Including STD and Pregnancy - Survey
  22. HIV Testing Assessment - Survey
  23. Global HIV Competence Assessment - Scale
  24. Getting Services Assessment - Survey
  25. General Medical History Assessment
  26. Multiple Problem Behavior - DSM Conduct Problems (DSMC) - Conduct Disorder
  27. Composite International Diagnostic Interview (CIDI)

HIV Counseling & Texting Program

The HIV Counseling and Texting (HCT) program utilizes social networks testing methodology, specifically designed to work with HIV infected and high-risk gay and bisexual men of color and transgender women. HIV infected or high-risk negative participants who either come to the Friends Community Center site for services or are contacted through street outreach and meet eligibility are invited to serve as recruiters. The engagement of new recruiters will be an active and ongoing part of the program. Potential recruiters attend a group orientation, which explains the social network methodology and informs potential recruiters that they will be requested to recruit individuals from their social, sexual or drug-using networks whom they believe to be at high-risk of HIV infection. Following the training period (brief identification, group orientation, individual interview), the recruiter begins to locate network associates to be referred to our testing site. Confirmatory HIV tests and STI testing (syphilis, Chlamydia, gonorrhea) are also available at the Friends Community Center site. Participants (both those who test HIV negative and positive) are then linked to appropriate medical, social, psychological, CRCS and other needed services. Network associates who wish to become recruiters are be assessed for eligibility and appropriateness.

This program is funded by the Los Angeles County, Department of Health Services, Office of AIDS Programs and Policy (OAPP).

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