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Effects of a HIV Behavioral Prevention Intervention for Mexican and Puerto Rican Women : SEPA. Nilda (Nena) Peragallo, RN, DrPH, FAAN Dean and Professor School of Nursing University of Miami. SEPA Project. S alud/Health E ducación/Education P revención/Prevention

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Effects of a hiv behavioral prevention intervention for mexican and puerto rican women sepa l.jpg

Effects of a HIV Behavioral Prevention Intervention for Mexican and Puerto Rican Women: SEPA

Nilda (Nena) Peragallo,

RN, DrPH, FAAN

Dean and Professor

School of Nursing

University of Miami


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SEPA Project Mexican and

Salud/Health

Educación/Education

Prevención/Prevention

Autocuidado/Self-Care

Funded by NIH / NINR

(P.I. Peragallo) R01 NR04746


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Goal of the Study Mexican and

  • Evaluate the effectiveness of a culturally specific intervention to prevent high-risk HIV sexual behaviors for inner city Latino women


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Address Diverse Populations Mexican and

  • Racial and ethnic minority populations are increasing in the United States. (In 2000, 32.8 million Latinos resided in the United States, representing 12.0 percent of the total U.S. population.)

  • As minority health care needs rise, so must the availability of services

  • Health care needs of minority populations are uniquely addressed by providers who are from the same minority group or individuals who are culturally competent with that particular groups.


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Early Release of UN Report Mexican and

  • AIDS cases accelerating worldwide

  • End of 2003 38 million cases

  • Up 10% over 2002

  • Could be 45 million new infections by 2010

  • Increased spending 300m to 5b

  • Only 1 in 5 people worldwide has access to AIDS prevention services

All information from newest UN report, as featured in The Miami Herald July 7, 2004, more can be found at unaids.org


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Women Catching up with Men Mexican and

  • A generation ago, 1 in 10 of new AIDS patients in the US was a woman. Now it’s 1 in 4.

  • Worldwide women made up ~ 50% of adults living with HIV/AIDS in 2003, up from 41% in 1997

  • In many societies women’s legal and social status is dependent to men’s and women may have little or no control over sexual behaviors of male partners and often cannot negotiate the use of condoms

Reports from the International AIDS Conference, feature in The Miami Herald July 9, 2004


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% Adult Women living with HIV/AIDS in 2003 Mexican and

  • Global 48%

  • Sub-Saharan Africa 57%

  • Caribbean 49%

  • Latin America 36%

  • Eastern Europe 33%

    & Central Asia

  • South/SE Asia 29%

  • North America 25%

  • East Asia 22%

From UN AIDS 2004 Report on Global AIDS, featured in The Miami Herald July 9, 2004


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Need for Culturally Tailored Interventions Mexican and

Department of Health and Human Services, HIV/AIDS Surveillance Report 2002, Volume 14

U.S. Census Bureau, Statistical Abstract of the United States, 2003, Table 13


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Cultural Tailoring Mexican and

  • HIV/AIDS prevention for Latino women is urgently needed

  • Social learning theory and cultural specificity are critical for successful intervention

  • Socio-economic and cultural inequalities

  • Inequalities in personal and sexual relations

  • Psychological inequalities


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Conceptual Framework Mexican and

Random

Group Assignment

Personal

Factors

Intervention

Experiences

Intermediate

Outcomes

HIV/AIDS

Prevention

Outcomes

Relationship

Factors


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Research Design Mexican and

  • Randomized pre-test/post-test comparison design and follow-up assessments at Baseline and 3 months

  • Facilitated by bilingual, bicultural, trained Latino women

  • 657 Sexually active Mexican and Puerto Rican women, aged 18 to 44


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Randomized Groups Mexican and

Complete

Intervention

Offered to GROUP 2

Offered in a 2 day period

(no payment)

Voluntary

Participation

3

6

Week 2

Week 3

Week 1

Week 4

Week 5

Week 6

6

GROUP 1

MONTHS

MONTHS

WEEKS

(Intervention)

$15 $15 $15 $15 $15 $15

*Interview 1

I n t e r v e n t i o n s

* Interview 2 * Interview 3

* Interview 4

(Immediate Post)

*HIV Pre-Test

$20 $30 $40

Counseling

$20

GROUP 2

3

6

6

(Control)

MONTHS

MONTHS

WEEKS

* Interview 1

* Interview 2 * Interview 3

* Interview 4

(Immediate Post)

* HIV Pre-Test

$20 $30 $40

Counseling

$20


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Intervention Mexican and

  • Six weekly sessions, two hours

    • Know your own body

    • Skill training on condom use

    • Sexual communication and negotiation

    • Conflict management


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Intervention (Cont.) Mexican and

  • Violence prevention

  • Problem solving

  • Risk awareness

  • Risk management

  • Peer support for change efforts



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Bidimensional Acculturation for Hispanics Mexican and

HIV behavior knowledge

Depression

Self efficacy

Substance Abuse

Communication with partner

Intimacy between partners

Conflict management

Conversations with male partners

about condoms and HIV/AIDS concerns

Condom use

Outcomes Measurement


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Data Collection & Sample Mexican and

  • Data Collection: Feb. 1999 to Mar. 2001

  • Sample Size:




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Analysis of Intervention Effects Mexican and

  • Multiple Linear & Logistic Regression

  • Adjusted by Baseline score of each dependent variable, acculturation, ethnicity, poverty, insurance, lived with partner


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Selected Outcomes Mexican and

  • Condom Use

  • Health Protective Communication

  • HIV Knowledge

  • Risk Reduction Behavioral Intentions

  • Perceived Condom Use Barriers


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Results (Cont.) Mexican and


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Results (Cont.) Mexican and


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Results (Cont.) Mexican and



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Conclusions & Implications Mexican and

  • Project SEPA was highly successful in increasing condom use, HIV health protective communication, and HIV knowledge and decreasing risk behaviors among low income, primarily Spanish speaking Latinas.


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Conclusions & Implications Mexican and

  • This study provided evidence that HIV/AIDS prevention interventions must be culturally tailored to the targeted population of the intended program.



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