Latino Sexual Beliefs Scale: An Exploratory Factor Analysis of Latino Men Who Have Sex With Men.

The catalyzing forces behind risky sexual behavior are a rich area of interest for public health researchers concerned with reducing HIV risk. Social cognitive theory would suggest that sexual beliefs are a viable example of one such influential agent. Recognizing that culture plays an important role in forming such sexual beliefs, and seeking to understand the unique HIV risks present for Latino men who have sex with men (MSM), this article presents an exploratory factor analysis of the 13-item Latino Sexual Beliefs Scale (LSBS) created as part of a larger study to investigate predictors of condom use among a sample of 482 MSM born in Brazil, Colombia, and the Dominican Republic and living in the U.S. The current analysis identified two psychometric factors in the LSBS as Romantic Exigency (containing six items with a mean loading of .62) and Sexual Acquiescence (containing seven items with a mean loading of .57). This is the first factor analysis conducted on the 13-item LSBS and represents the first known quantitative measure of Latino cultural sexual beliefs related to condom use for Latino MSM. Implications for future research include further validation, use in studies exploring the role of sexual beliefs on condom use, and possible thematic targets in HIV risk reduction interventions.

A systematic community-based participatory approach to refining an evidence-based community-level intervention: the HOLA intervention for Latino men who have sex with men.

Our community-based participatory research partnership engaged in a multistep process to refine a culturally congruent intervention that builds on existing community strengths to promote sexual health among immigrant Latino men who have sex with men (MSM). The steps were the following: (1) increase Latino MSM participation in the existing partnership, (2) establish an Intervention Team, (3) review the existing sexual health literature, (4) explore needs and priorities of Latino MSM, (5) narrow priorities based on what is important and changeable, (6) blend health behavior theory with Latino MSM's lived experiences, (7) design an intervention conceptual model, (8) develop training modules and (9) resource materials, and (10) pretest and (11) revise the intervention. The developed intervention contains four modules to train Latino MSM to serve as lay health advisors known as Navegantes. These modules synthesize locally collected data with other local and national data; blend health behavior theory, the lived experiences, and cultural values of immigrant Latino MSM; and harness the informal social support Latino MSM provide one another. This community-level intervention is designed to meet the expressed sexual health priorities of Latino MSM. It frames disease prevention within sexual health promotion.

A randomized controlled trial of a culturally congruent intervention to increase condom use and HIV testing among heterosexually active immigrant Latino men.

This randomized controlled trial tested the efficacy of an HIV prevention intervention to increase condom use and HIV testing among Spanish-speaking, heterosexually active immigrant Latino men. A community-based participatory research partnership developed the intervention and selected the study design. Following baseline data collection, 142 immigrant Latino men were randomized to the HIV prevention intervention or the cancer education intervention. Three-month follow-up data were collected from 139 participants, for a 98% retention rate. Mean age of participants was 31.6 years and 60% reported being from Mexico. Adjusting for baseline behaviors, relative to their peers in the cancer education comparison, participants in the HIV prevention intervention were more likely to report consistent condom use and receiving an HIV test. Community-based interventions for immigrant Latino men that are built on state of the art prevention science and developed in partnership with community members can greatly enhance preventive behaviors and may reduce HIV infection.

Men Who Have Sex With Men and HIV Risk Behavior: Exploring the Influence of Masculinity Within the Social Ecological Model.

In the United States, gay, bisexual men, and men who have sex with men (MSM) represent 86% of new HIV infections among males. Approximately 1 in 7 men with HIV are unaware of their HIV status (CDC, 2017, 2019a, 2020a). To explore influences on MSM HIV risk behavior, the authors performed a systematic review of quantitative studies conducted in the U.S. assessing what is purported as masculinity. From 30 identified studies, significant findings were framed within the Social Ecological Model (SEM) levels (e.g., Individual, Relationship, Community). SEM level themes were applied to create the Masculinity 10, a preliminary 10-item assessment to explore the influence of masculinity on MSM HIV risk behavior. To increase MSM engagement in HIV prevention and treatment, the influences of masculinity (e.g., attitude toward sexual minorities, appearance, emotion, temperament, substance use, sexual activity, social support, intimate relationships, health care) on HIV risk behavior should be further explored.

A pilot intervention utilizing Internet chat rooms to prevent HIV risk behaviors among men who have sex with men.

OBJECTIVES: Chat room-based prevention interventions for human immunodeficiency virus (HIV) are being implemented to reduce the risk of HIV exposure, infection, and re-infection among men who have sex with men (MSM). METHODS: Our community-based participatory research partnership implemented a chat room-based intervention known as Cyber-Based Education and Referral/Men for Men (CyBER/M4M). We collected both quantitative and qualitative data to describe the characteristics of chat-room participants ("chatters") and their HIV risks and prevention needs, and to document intervention delivery. RESULTS: Of the 1,851 chatters who participated in the 18-month intervention, 210 completed the online assessment. The mean age was 30 years. Although the majority self-identified as gay, 25.8% self-identified as bisexual. More than half self-identified as white and one-third as black or African American. A total of 8.6% reported being HIV-positive and 14.8% reported never having been tested for HIV. Grounded theory analysis of transcripts from chat-room instant-message discussions identified 13 thematic categories related to chatter characteristics, prevention needs, and intervention delivery. Chatters were looking for sexual partners, were not open about their orientation, lacked basic information about HIV, had questions about how to be tested, and perceived a lack of general community resources to meet their needs. Furthermore, CyBER educators had to understand and respect the online culture, build trust, and deliver well-crafted and focused messages. CONCLUSIONS: Chat room-based interventions hold promise to systematically reach Internet communities of MSM, a group that is particularly at risk for infection with HIV and other sexually transmitted diseases.

Latino men who have sex with men and HIV in the rural south-eastern USA: findings from ethnographic in-depth interviews.

A community-based participatory research partnership explored HIV risk and potentially effective intervention characteristics to reduce exposure and transmission among immigrant Latino men who have sex with men living in the rural south-eastern USA. Twenty-one participants enrolled and completed a total of 62 ethnographic in-depth interviews. Mean age was 31 (range 18-48) years and English-language proficiency was limited; 18 participants were from Mexico. Four participants reported having sex with men and women during the past three months; two participants self-identified as male-to-female transgender. Qualitative themes that emerged included a lack of accurate information about HIV and prevention; the influence of social-political contexts to sexual risk; and barriers to healthcare services. We also identified eight characteristics of potentially effective interventions for HIV prevention. Our findings suggest that socio-political contexts must be additional targets of change to reduce and eliminate HIV health disparities experienced by immigrant Latino men who have sex with men.

Sexual and alcohol risk behaviours of immigrant Latino men in the South-eastern USA.

Little is known about the intersections of immigration, masculinity and sexual risk behaviours among recently arrived Latino men in the USA. Nine immigrant Latino men from three urban housing communities in the South-eastern USA used photovoice to identify and explore their lived experiences. From the participants' photographs and words, thirteen themes emerged within four domains. The immigration experience and sociocultural norms and expectations of masculinity were factors identified decreasing Latino men's sense of power and increasing stress, which lead to sexual risk. Latino community strengths and general community strengths were factors that participants identified as promoting health and preventing risk. These themes influenced the development of a conceptual model to explain risk among immigrant Latino men. This model requires further exploration and may prove useful in intervention development.

Characteristics of immigrant Latino men who utilize formal healthcare services: baseline findings from the HoMBReS study.

Despite the burgeoning immigrant Hispanic/Latino community in the southeastern United States, little is known about the utilization of healthcare services by this population. We sought to identify demographic, behavioral and psychosocial characteristics of immigrant Hispanic/Latino men who report utilizing formal healthcare services. Using an interviewer-administered assessment, data were collected from a random sample of members of a multicounty adult Latino men's soccer league in North Carolina. Of the 222 participants, the mean (+/-SD) age was 29.8 +/-8.3, with a range of 18-71 years. More than half of the sample reported Mexico as their country of origin and grade < or =8 as their highest level of education. The mean length of time living in the United States was 8.8 (+/- 7.6) years. An increased likelihood of reporting having ever utilized formal healthcare services associated with decreased perceived barriers to utilization, increased acculturation, increased adherence to traditional notions of masculinity and increased coping. Effective strategies to increase the utilization of formal healthcare services among Hispanic/Latino men may include diffusing information about the availability of services and how to access services and linking healthcare utilization with positive aspects of what it means to be a man.

Visions and Voices: indigent persons living with HIV in the southern United States use photovoice to create knowledge, develop partnerships, and take action.

Little is known about the experiences of persons living with HIV/AIDS (PLWHA) in some regions of the United States that are disproportionately affected by HIV/AIDS. "Visions and Voices: HIV in the 21st Century" was an exploratory study to gain insight into the life experiences of 15 indigent PLWHA. The study used photovoice to uncover the realities of living with HIV/AIDS though photographic documentation and Freirean-based critical dialogue and facilitate a process for PLWHA to reach local community members and leaders, policy makers, and advocates to develop plans of action and effect change. From the participants' photographs and words, seven themes emerged and were presented during a community forum. Three main outcomes occurred, including a participant-developed and locally funded gallery exhibition to address HIV/AIDS misinformation and stigma; a new partnership with the public health department to use PLWHA in their prevention programming; and increased community efforts to address substance use.

Attitudes and beliefs about hepatitis B vaccination among gay men: the Birmingham Measurement Study.

This study was designed to develop reliable and valid quantitative measures of the beliefs and attitudes toward hepatitis B virus (HBV) vaccination among gay men, using a community-based participatory research approach. A convenience sample of 358 gay men was recruited in two gay bars. Exploratory factor analysis performed on the first split-half sample was used to assess the factor structure from five scales measuring beliefs about HBV vaccination. The scales were based on constructs from the health belief model and the social cognitive theory. Confirmatory factor analysis was performed on the remaining half-sample using structural equation modeling. Multivariable analysis further validated the scales. These findings propose standardized measures that may be useful in assessing the beliefs and attitudes of gay men toward HBV vaccination to guide intervention design and evaluation.

Characteristics of a sample of men who have sex with men, recruited from gay bars and Internet chat rooms, who report methamphetamine use.

Crystal methamphetamine is a highly addictive stimulant that initially gained popularity in the western region of the United States and has spread to all regions of the country. This study was designed to identify factors associated with methamphetamine use among men who have sex with men (MSM) in North Carolina. Participants were recruited in five gay bars and in five geographically defined Internet chat rooms concurrently in 2005 to complete a brief assessment of drug use and other risk behaviors. Of the 1189 MSM who completed the assessment, mean age was 29 years. Two thirds self-identified as black/African American or other minorities, and 25% as bisexual. Nearly 6% reported using methamphetamines during the past 30 days. In multivariable analysis, MSM who reported using methamphetamines were more likely to report higher education; health insurance coverage; inconsistent condom use during anal sex within the past 3 months; a history of sexually transmitted disease (STD) infection; positive HIV serostatus; and use of medications designed to treat erectile dysfunction. A lack of data exists on methamphetamine use among MSM in the southeastern United States, particularly in nonurban regions. Because the southeastern United States carries a disproportionate HIV, AIDS, and STD burden, our findings underscore the need for further research and intervention.

Exploring Latino men's HIV risk using community-based participatory research.

OBJECTIVES: To explore sociocultural determinants of HIV risk and identify potential intervention approaches among adult Latino men. METHODS: Using community-based participatory research for study design and implementation and data analysis, 7 focus groups were conducted with members of a soccer league in central North Carolina. RESULTS: Five themes emerged, including perceived barriers to accessing health care, the role of hegemonic masculinity in risk, and potentially effective intervention approaches to health promotion and disease prevention. CONCLUSIONS: Latino soccer leagues may provide an effective social network with which to partner to design, implement, and evaluate interventions to reduce sexual risk among Latino men, who have been inaccessible in conventional HIV/ STD prevention programs.

Windows to work: exploring employment-seeking behaviors of persons with HIV/AIDS through Photovoice.

The advent of health-enhancing protease inhibitors and highly active antiretroviral therapy has enhanced the longevity for persons living with HIV/AIDS (PLWHA), increasing the number of PLWHA returning to employment. Based on community-based participatory research, the Photovoice method was used to identify the influences upon the employment-seeking behavior of 11 PLWHA who were unemployed and had full-time employment histories after their initial HIV/AIDS diagnosis. Through group discussion and photograph presentations, participants identified 19 factors which they grouped into five categories: (a) advantages of employment, (b) disadvantages of employment, (c) referents influencing employment decisions, (d) facilitators for employment, and (e) impediments to employment. Participants utilized these findings to develop action plans to address the employment-seeking behavior of PLWHA. The findings also suggest the utility of Photovoice to enhance employment outcomes for PLWHA.

Using community-based participatory research to develop an intervention to reduce HIV and STD infections among Latino men.

Although the Latino community living in the United States has been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs), the development, implementation, and evaluation of HIV and STD prevention interventions designed to reduce infection among Latinos lags behind prevention efforts targeting other communities. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables is a sexual risk reduction intervention designed to reduce HIV and STD infection among recently arrived, non-English-speaking Latino men who are members of a multicounty Latino soccer league in central North Carolina, a region of the United States with both the fastest growing Latino population and disproportionate HIV and STD infection rates. HoMBReS was developed in partnership with the local Latino community using community-based participatory research (CBPR). We describe (a) the CBPR partnership history and further expansion; (b) the development of the intervention through the integration of collected formative data, theoretical considerations, and findings from the scientific literature; and (c) lessons learned while using a CBPR approach to develop HoMBReS.

Preventing HIV infection among young immigrant Latino men: results from focus groups using community-based participatory research.

Latinos in the United States have been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs). Using a community-based participatory research (CBPR) approach to problem identification and exploration, a total of 74 Latino men (mean age 22.3, range 18-37) residing in an urban city in northwest North Carolina participated in one of eight focus groups on sexual health. Among the findings of this study, >75% of participants reported Mexico as their country of origin; other participants reported being from Central and South American countries. Qualitative data analysis identified 13 themes, which were grouped into the following three domains: 1) psychosocial factors identified as influencing sexual risk health behaviors; 2) system-level barriers to sexual health; and 3) characteristics of potentially effective HIV prevention intervention approaches. The study findings suggest that community-based, male-centered interpersonal networks that provide individual and group education and skill-building and incorporate curanderos (Latino healers) and bilingual experts may be important elements of potentially effective intervention approaches to reach Latino men, who have been inaccessible to conventional HIV prevention programs.

Enhancing HIV Prevention Among Young Men Who Have Sex With Men: A Systematic Review of HIV Behavioral Interventions for Young Gay and Bisexual Men.

Men who have sex with men (MSM) represent 64.0% of people living with HIV (PLWH) over the age of 13 years. Young men who have sex with men (YMSM) are particularly affected by HIV/AIDS; the rate of HIV infection for YMSM between the ages of 13 and 24 represents 72.0% of new infections among youth. To understand the current state of the science meant to prevent HIV for YMSM, we reviewed studies of HIV behavioral prevention interventions for YMSM. Five literature databases were searched, from their inception through October 2015, using key words associated with HIV prevention intervention evaluation studies for YMSM. The review criteria included behavioral HIV/AIDS prevention interventions, articles published in English-language peer-reviewed journals, YMSM between 13 and 24 years of age, and longitudinal repeated measures design. A total of 15 YMSM behavioral HIV prevention intervention studies were identified that met inclusion criteria and reported statistically significant findings. Common outcomes included unprotected sexual intercourse, HIV/AIDS risk behavior, condom use, HIV testing, safer sex attitude, and HIV prevention communication. Participant age, representation of Black/African American YMSM, application of theoretical and model underpinnings, congruence of assessment measures used, follow-up assessment times, and application of process evaluation were inconsistent across studies. To advance HIV prevention intervention research for YMSM, future studies should be theory-based, identify common constructs, utilize standard measures, include process evaluation, and evaluate sustained change over standard periods of time. HIV prevention interventions should incorporate the needs of the diverse, well-educated, web-connected millennial generation and differentiate between adolescent YMSM (13 to 18 years of age) and young adulthood YMSM (19 to 24 years of age). Because Black/African American YMSM represent more than 50% of new HIV infections, future HIV prevention intervention studies should prioritize these young men.

The employment perspectives study: identifying factors influencing the job-seeking behavior of persons living with HIV/AIDS.

Given the increased quality and length of life of persons living with HIV/AIDS (PLWHA), this study explored factors influencing the job-seeking behaviors of PLWHA, using the theory of planned behavior. We conducted six focus groups with 54 persons living with HIV/AIDS who self-identified as African American, reported receiving HIV/AIDS services at an urban AIDS service organization in metropolitan Washington, DC, and reported not being employed. Most participants reported no employment history and were not receiving public assistance. Among the findings of this study, participants reported valuing employment, identified advantages and disadvantages associated with employment while managing their HIV/AIDS prognosis, identified individuals influencing their decision to become employed, and delineated facilitators and impediments to employment. The findings identified 15 beliefs that may be key for community-based organizations and agencies to address when providing job placement services for PLWHA.

Risk among men who have sex with men in the United States: a comparison of an Internet sample and a conventional outreach sample.

This study compared the demographics and risk behaviors of two samples of men who have sex with men (MSM), using cross-sectional data that were collected via the Internet and through conventional bar-based outreach. The Internet sample was significantly older, more likely to identify as "bisexual," and less educated than the bar sample. After controlling for age and education, few differences were observed between the samples. However, three variables that markedly differentiated the samples were history of sexually transmitted disease infection, HIV serostatus, and sources utilized to obtain health information. No difference in Internet use was found. Based on the possible decreased social desirability promoted by the use of electronic data collection methodologies, these findings provide preliminary evidence that Internet and bar respondents are similar and that the Internet may serve as an expedient as well as reliable methodology to increase understanding of risk among MSM.

Increasing hepatitis B vaccination among young African-American men who have sex with men: simple answers and difficult solutions.

Using a bar-based sample, we identified factors associated with hepatitis B virus (HBV) vaccination among young African American men who have sex with men (MSM). The mean (+/- standard deviation [SD]) age of the 170 participants was 26 +/- 6.5 years. Nearly 40% reported at least one dose of vaccine; the remainder were completely unvaccinated. Approximately 22% (37) reported having never heard of HBV. Less than 7% of participants reported using condoms the majority of the time during oral intercourse within the past 3 months, and approximately 50% reported using condoms the majority of the time during anal intercourse within the past 3 months. In multivariable analysis, variables associated with vaccination were younger age (odds ratio [OR], 0.44 per 10-year increase in age; 95% confidence interval [CI]: 0.21-0.93, p = 0.032), higher educational attainment (OR, 4.6; 95% CI: 1.17-12.59, p = 0.003), homosexual as opposed to bisexual behavior (OR, 0.15; 95% CI: 0.06-0.41, p = 0.0001), and recent visits to a health care provider (OR, 4.31; 95% CI: 2.08-8.94, p = 0.0001). Our findings underscore the need to reach MSM for HBV vaccination. Innovative approaches are necessary to ensure the prevention of infection, transmission and disease among individuals with limited education, bisexual MSM, and men who have limited access to health care.

Hepatitis A vaccination among young African American men who have sex with men in the deep south: psychosocial predictors.

Despite recommendations for vaccination against hepatitis A (HAV) of men who have sex with men (MSM), most remain unvaccinated. This study was designed to identify attitudes and beliefs associated with vaccination against HAV using a conventional outreach sample of African American MSM in Birmingham, Alabama. Of 107 participants, nearly 34% reported being vaccinated against HAV. Over half of the participants reported 10 or more different lifetime male sexual partners, and a third reported having had intercourse with females, as well as, males within the past 5 years. About 10% of the participants reported condom use over half of the time during oral intercourse, and 50% of the participants reported using a condom over half the time during anal intercourse. In multivariable analysis, predictors of HAV vaccination were a decreased perception of the practical barriers to HAV vaccination (odds ratio [OR], 0.05; 95% confidence interval [CI]: 0.01-0.18, P = 0.002); increased health provider communication (OR, 9.89; 95% CI: 2.74-35.65, P = 0.02); and increased perceived personal self-efficacy to complete the two-dose series (OR, 7.31; 95% CI: 2.38-22.45, P = 0.02). Our findings underscore the need to increase vaccination through innovative approaches to reduce perceived barriers to vaccination while increasing provider-patient communication and self-efficacy to complete the vaccine series.