title: Integration of Social, Cultural, and Biomedical Strategies into an Existing Couple-Based Behavioral HIV/STI Prevention Intervention: Voices of Latino Male Couples.
abstract: BACKGROUND
  Successful HIV prevention and treatment requires evidence-based approaches that combine biomedical strategies with behavioral interventions that are socially and culturally appropriate for the population or community being prioritized. Although there has been a push for a combination approach, how best to integrate different strategies into existing behavioral HIV prevention interventions remains unclear. The need to develop effective combination approaches is of particular importance for men who have sex with men (MSM), who face a disproportionately high risk of HIV acquisition.
  
  
  METHODS
  We collaborated with Latino male couples and providers to adapt Connect 'n Unite, an evidence-based intervention for Black male couples, for Latino male couples. We conducted a series of three focus groups, each with two cohorts of couples, and one focus group with providers. A purposive stratified sample of 20 couples (N = 40, divided into two cohorts) and 10 providers provided insights into how to adapt and integrate social, cultural, and biomedical approaches in a couples-based HIV/AIDS behavioral intervention.
  
  
  RESULTS
  The majority (N = 37) of the couple participants had no prior knowledge of the following new biomedical strategies: non-occupational post-exposure prophylaxis (nPEP); pre-exposure prophylaxis (PrEP); and HIV self-testing kits. After they were introduced to these biomedical interventions, all participants expressed a need for information and empowerment through knowledge and awareness of these interventions. In particular, participants suggested that we provide PrEP and HIV self-testing kits by the middle or end of the intervention. Providers suggested a need to address behavioral, social and structural issues, such as language barriers; and the promotion of client-centered approaches to increase access to, adaptation of, and adherence to biomedical strategies. Corroborating what couple participants suggested, providers agreed that biomedical strategies should be offered after providing information about these tools. Regarding culturally sensitive and responsive approaches, participants identified stigma and discrimination associated with HIV and sexual identity as barriers to care, language barriers and documentation status as further barriers to care, the couple-based approach as ideal to health promotion, and the need to include family topics in the intervention.
  
  
  CONCLUSIONS
  We successfully adapted an evidence-based behavioral HIV prevention intervention for Latino male couples. The adapted intervention, called Conectando Latinos en Pareja, integrates social, cultural, behavioral and biomedical strategies to address the HIV epidemic among Latino MSM. The study highlights the promise regarding the feasibility of implementing a combination approach to HIV prevention in this population.
authors.affiliation: School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Omar
authors.initials: O
authors.lastname: Martinez
authors.affiliation: School of Social Work, Columbia University, New York, New York, United States of America.
authors.forename: Elwin
authors.initials: E
authors.lastname: Wu
authors.affiliation: College of Liberal Arts, Temple University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Ethan C
authors.initials: EC
authors.lastname: Levine
authors.affiliation: School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Miguel
authors.initials: M
authors.lastname: Muñoz-Laboy
authors.affiliation: College of Osteopathic Medicine, Nova Southeastern University, Fort Lauderdale, Florida, United States of America.
authors.forename: M Isabel
authors.initials: MI
authors.lastname: Fernandez
authors.affiliation: School of Public Health, Temple University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Sarah Bauerle
authors.initials: SB
authors.lastname: Bass
authors.affiliation: School of Social Work, University of Texas at El Paso, El Paso, Texas, United States of America.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Moya
authors.affiliation: HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States of America.
authors.forename: Timothy
authors.initials: T
authors.lastname: Frasca
authors.affiliation: School of Social Work, University of Texas at El Paso, El Paso, Texas, United States of America.
authors.forename: Silvia
authors.initials: S
authors.lastname: Chavez-Baray
authors.affiliation: School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States of America.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Icard
authors.affiliation: Lutheran Family Health Centers, New York, New York, United States of America.
authors.forename: Hugo
authors.initials: H
authors.lastname: Ovejero
authors.affiliation: HIV Center for Clinical and Behavioral Studies, Columbia University, New York, New York, United States of America.
authors.forename: Alex
authors.initials: A
authors.lastname: Carballo-Diéguez
authors.affiliation: Wake Forest University Medical Center, Winston-Salem, North Carolina, United States of America.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Rhodes
mesh_terms: D000328:Adult; D003466:Cultural Characteristics; D005191:Family Characteristics; D015658:HIV Infections / Q000517:prevention & control*; D006630:Hispanic or Latino; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D012309:Risk-Taking; D021841:Safe Sex; D014481:United States