Rhonda Bohs, Ph. DSpectrum Programs Inc. Miami Behavioral Health Center

Vice-President of Research and Clinical Development

Maria Elena Villar, Ph.D.Florida International University

Assistant ProfessorSchool of Journalism and Mass Communication

Moving Beyond the Comadres/Compadres

Model

ACKNOWLEDGEMENTS This study was supported by award number P20MD002288 from the National Institute on Minority Health and Health Disparities. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Minority Health and Health Disparities, or the National Institutes of Health

.

Spectrum Programs Inc. and Miami Behavioral Health Center

MBHC located in Miami, Florida has conducted their services with SPI since 2003 predominantly serving the Hispanic/ Latino community.

SPI located in Miami-Dade and Broward County is the oldest and largest non-profit substance abuse treatment provider in South Florida.

MBHC has served the Latino community (children, adults, and severely mentally ill and substance abusing) since 1977 providing both mental health and substance abuse services.

Latinos and HIV Testing Latinos are more likely than other

ethnicities to be tested for HIV late in their illness.

Latinos are more likely to be public insured or uninsured when compared to other groups.

Latinos are more likely to report postponing medical care due to transportation or being too sick to go to doctor.

Latinos are more likely to under-utilize services due to socio-economic challenges, poverty.

Our focus: Behavioral Health Clients and their Risks

More prone to homelessness and poverty as well as lack access to health care and other basic necessities.

More likely to present cognitive deficiencies and reduced social and interpersonal skills (Parry, Blank, & Pithey, 2007), leading to increased risk-taking behavior and probability of ending up in risky situations.

In addition, multiple sex partners; unprotected sex, and engaging in injection drug use.

Individuals with co-occurring mental health and substance use disorders appear to experience the most severe risks relative to engaging in these behaviors (Parry et al, 2007)

HIV Stigma and Peer Interventions

Social stigma of HIV & drug use may decrease perceived susceptibility and social support for screening and treatment

Research is lacking on the effectiveness of peer health advisors/community health workers for HIV & substance abuse

Peer interventions have been used to challenge health related cultural beliefs

There is a need for further study on the specific attitudes and beliefs associated with testing and other screening/prevention behavior

Why assess stigma?Previous research describes participants reporting lower testing intentions for a stigmatized disease than for a non-stigmatized disease

participants were found to diminish their perceived risk for contracting the disease when they were informed it could be transmitted through unprotected sex in addition to other non-sexual means, and their intentions to be tested for the disease were consequently reduced.

The study indicates that when a disease carries moral stigma, people are increasingly unwilling to test for it so as to uphold a good moral image (Young, Nussbaum, & Monin, 2007).

HIV Attitudes and Beliefs

Previous studies show that HIV testing behavior is negatively related to

misinformationmisguided beliefs about HIVstigmatized attitudes towards HIV

Comadres/ Compadres Literally means: godmother/godfather

because Latinos extend respect and loyalty to comadres/compadres.

Focus on linking people to primary and secondary prevention on substance use and HIV.

Objectives: Document the County’s HIV/AIDS and Substance

Abuse Prevention and Treatment Resources Recruit, Select, and Train Comadres/Compadres Collect Participant Surveys for information on:

(1)knowledge of HIV/Substance use consequences; (2) actual HIV and substance use risk behaviors; (3)needs for connection to prevention and treatment services; (4) knowledge of HIV/AIDS and substance abuse service providers

Participant Focus Groups

Health Educator Model Link and connect individuals to services in

the community. Community Health workers live in the same

neighborhoods as the individuals they serve.

Use community empowerment as a tool to reduce health care burdens.

Outreach, education and follow-up of underserved populations.

Model can be used for breast cancer, diabetes, or HIV education.

Training

Training:5 sessions over 5 weeks; trained by

Spectrum staffCurriculum was modified from

“Community Voices: Healthcare for the Underserved Project”

Included modules on (a) role of community health coaches, (b) Latino health disparities, HIV & substance abuse, (c) Coaching skills & (d) community resources.

The Intervention Developed a curriculum based on the

principles of Community Voices.

Consists of Four Modules Module 1: Identify the roles of

community health coaches What are the values guiding the work of

community health coaches? Module 2: Educate Comadres and

Compadres on Latino health disparities HIV/AIDS Substance Abuse

Module 3: Provide the trainees with coaching skills necessary to conduct outreach, education, and advocacy activities in their clinic

Communication and Presentation skills Problem solving skills Team Building skills Setting goals and objectives

The Intervention

Module 4: Identify Community Resources

HIV/AIDS Substance abuse

Recognition: Certificate of Accomplishment

Supervision: Weekly meetings with supervisors to discuss accomplishments, challenges, and to provide peer support.

The Intervention

Data CollectionSites Intervention was pilot-tested at a Community Behavioral

Health Center2 Control sites were included in survey: a Latino

Residential Program and an Outpatient Clinic Control sites were exposed to standards of state

mandated HIV education

Data Collection140-item knowledge & attitude questionnaire

Items addressed: (a) knowledge of existing services, (b) unmet service needs, (c) attitudes & beliefs toward HIV & substance abuse, (d) intent to be tested for HIV and/or substance use, (e) reasons for intention to be tested.

3 point scales (agree-neutral-disagree)Post test was administered 5 months after intervention

Participant Demographics

N= 72 pre; 62 postPre-test demographics

Mean age: 44.9, SD=13.858.3% male; 41.7% female40.8% single; 18.3% married; 28.2% divorced; 5.6%

widowed15.5% college grad or grad school; 21.1% high

school grad; 26.7% trade school or some college; 25.3% elementary or middle school only

77.5% born outside US; mean yrs in US=18.8, SD=12.01

83.8% identify as white; 7.4% as black; 8.8% mixed race

45.8% identified as Hispanic; 33.3% as Latino; 5.6% as Hispanic Latino; 6.9% as American

75.7% speak Spanish at home; 12.9 English; 11.4 Spanglish

Summary of Pre-TestHIV/AIDS: Knowledge• Knowledge on the nature of HIV was high• Knowledge on the transmission of HIV was

comparatively low.• Prevalent misconceptions about

• Transmission of HIV• Ability to identify people with HIV by looking at

them.

HIV/AIDS: Attitudes & beliefs • Attitudes towards people living with HIV was

somewhat negative, but not across the board. • Most participants did not blame homosexuals for

transmitting HIV, and did not consider it a punishment from God.

There were differences in attitudes and beliefs between testing behavior groups

Greater stigmatized beliefs among those not interested in testing

Greater misinformation about those never tested and not willing to be tested

Reasons for testing or not testing related to perceptions of personal risk and exposure.

Summary of Pre-Test

Results Pre/Post Attitudes

AIDS Knowledge

Results: Pre/Post AIDS Attitudes

Results: Pre-Post Attitudes

Intervention vs. control

Paired Samples t-tests

Chi Square Analysis

Results: Pre-Post Attitudes

Intervention vs. control

DiscussionMisconceptions about HIV transmission overestimate the

risk of transmission, but this did not make participants more likely to be tested.

May be explained by the effect of stigma. Misconceptions about who is affected lead to reduced perceptions of

riskIncreasing knowledge by reinforcing accurate beliefs

about transmission of HIV and HIV risk may increase willingness to be tested among Latino behavioral health clients.

While no causal relationships can be inferred between beliefs, stigmatized attitudes and HIV testing, findings need for experimental research to determine whether modifying these beliefs and attitudes would influence testing intent.

Lessons LearnedLatinos still report engaging in risky unprotected sex

contributing to health disparities and disproportionate HIV/AIDS and substance abuse prevalence and incidence rates.

Hispanics do not perceive to be “at risk” or are not aware of having a problem

Latinos have a disproportionate rate of substance use (alcohol, marijuana, cocaine)

Low levels of perceived risk may be contributing to “pre-contemplative stance” and resistance towards change

Future StepsUse of Stages of Change Model to increase

Hispanics’ readiness to seek treatment and prevention services.

Through Stages of Change motivate individuals to be well informed about getting tested and results.

Increase awareness of risk factorsIndividualized one-on-one home interventions

to dispel erroneous beliefs that contribute to stigmas attached to those individuals

Question / Answer