Project Salud: Efficacy of a Community-Based HIV Prevention Intervention for Hispanic Migrant Workers in South Florida
Project Salud evaluates the efficacy of a community-based intervention to reduce risk behaviors and enhance factors for HIV-preventative behaviors. A randomized controlled trial of 278 high risk Latino migrant workers was conducted between 2008 and 2010. Participants completed an audio computer-assisted self-interview questionnaire at baseline and 3- and 9-month post-intervention follow-ups. Participants were randomly assigned to the community-based intervention (A-SEMI) or the health promotion condition (HPC). Both interventions consisted of four 2.5-hour interactive sessions and were structurally equivalent in administration and format. Relative to the comparison condition, A-SEMI participants reported more consistent condom use, were less likely to report never having used condoms, and were more likely to have used condoms at last sexual encounter during the past 90 and 30 days. A-SEMI participants also experienced a positive change in regard to factors for HIV-preventive behaviors over the entire 9-month period. Our results support the implementation of communitybased, culturally tailored interventions among Latino migrant workers.
Available from: Jesus Sanchez
- "The main objective of Project Salud was to assess the differential effectiveness of an adapted stage-enhanced motivational interviewing (A-SEMI) intervention compared with a health promotion comparison (HPC) condition for producing reductions in HIV risk and increasing health behaviors among LMWs in the Homestead area of South Florida. The design of the A-SEMI intervention is considered to be an enhancement over existing cognitive behavioral risk reduction approaches because A-SEMI integrates key contextual components from effective HIV prevention interventions (i.e., peer counseling) linked to maintenance of risk reduction effects while culturally adapting these components to the specific needs of the LMW community (29). "
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ABSTRACT: Introduction: Although the literature on self-medication among Latino migrant workers (LMWs) is sparse, a few existing studies indicate that this practice is common in this community. The purpose of this paper is to estimate health status, access to health care, and patterns of self-medication practices of a cohort of LMWs in South Florida.
Methods: A stratified network-based sample was utilized to recruit 278 LMWs in the Homestead area. After screening for eligibility, participants were administered a structured questionnaire that collected data on their health status, access to health care services, and self-medication practices. A convenience sample of 24 LMWs, who participated in the parent study were invited back to participate in 3 focus groups to look more in depth into self-medication practices in the LMW community.
Results: Study findings indicate that LMWs are affected by a vast array of health problems yet lack access to health care services. Participants already engaged in self-medication practices in the countries of origin and, upon their arrival in the US, these practices continue and, in many cases, increase.
Conclusion: Long-held traditions and lack of access to the formal health care system in the US contribute to the high prevalence of self-medication among LMWs. Self-medication practices such as the use of prescription medications without a prescription and lay injection are high risk practices that can have harmful consequences. Prevention interventions that address self-medication in the LMW community are likely to be most effective if they are culturally adapted to the community and facilitate access to health care services.
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Brief intervention is known to reduce drinking in primary care; however, because health care access is limited for Latino immigrants, traditional brief interventions are unlikely to reach this population.
Using Barrera and Castro's framework, our study aims to culturally adapt a screening and brief intervention program to reduce unhealthy alcohol use among Latino day laborers, a particularly vulnerable group of Latino immigrant men. We conducted 18 interviews with Latino day laborers and 13 interviews with mental health and substance use providers that serve Latino immigrant men. Interviews were conducted until saturation of themes was reached. Themes from interviews were used to identify sources of mismatch between traditional screening and brief intervention in our target population.
Unhealthy alcohol use was common, culturally accepted, and helped relieve immigration-related stressors. Men had limited knowledge about how to change their behavior. Men preferred to receive information from trusted providers in Spanish. Men faced significant barriers to accessing health and social services but were open to receiving brief interventions in community settings. Findings were used to design Vida PURA, a preliminary adaptation design of brief intervention for Latino day laborers. Key adaptations include brief intervention at a day labor worker center provided by promotores trained to incorporate the social and cultural context of drinking for Latino immigrant men.
Culturally adapted brief intervention may help reduce unhealthy drinking in this underserved population.
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