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Compendium of Evidence-Based Interventions and
Best Practices for HIV Prevention

HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables (Men Maintaining Wellbeing and Healthy Relationships)

BEST-EVIDENCE

Intervention Description

Target Population
Recently immigrated, sexually active heterosexual Latino men in rural areas

Goals of Intervention

  • Increase condom use
  • Increase HIV testing
  • Enhance the determinants of prevention behaviors

Brief Description

HoMBReS is a community-level intervention developed for a rural Latino soccer league. Teams, comprised of 20 to 25 players, each elects one opinion leader who is trained as a lay health adviser, known as a Navegante or navigator. Navegantes complete 16 hours of training in 4 sessions. Session 1 is focused on providing an overview of HoMBReS including the purpose, the roles and responsibilities of Navegantes, and how to use the HoMBReS Resource Manuals and risk-reduction materials. Session 2 provides information about common STI, correct HIV prevention information, and how to distinguish facts from misperceptions. In this session, Navegantes learn how to model correct HIV prevention behavior though activities focused on proper condom use and how to share HIV prevention resources and information with their teammates. The remaining 2 sessions focus on the specific roles and responsibilities of being a Navegante and how to evaluate program progress through activity logs and team member interviews. After completing the training, the Navegantes work to improve their community’s health (1) as lay health advisers providing HIV/STI information, condoms, and referrals and increasing condom use skills, (2) as opinion leaders bolstering positive attitudes and reframing negative attitudes about what it means to be a Latino man and changing sexual health attitudes and norms, and (3) as community advocates for environmental change bringing the community voice to health service agencies. Navegantes hold monthly meetings to plan, coordinate, and evaluate their ongoing activities.

Theoretic Basis

  • Empowerment education
  • Social cognitive theory

Intervention Duration

  • Four 4-hour training sessions for Navegantes over two consecutive weekends
  • Ongoing diffusion of HIV prevention information and materials through Navegante-delivered activities

Intervention Setting(s)
Local restaurant, Latino soccer team communities

Deliverer
Facilitators for the Navegante training and Navegantes as lay health advisers to soccer teammates

Delivery Method(s)

  • Navegante training
    • Demonstration
    • Discussion
    • Exercises
    • Lecture
    • Printed materials
  • Demonstration
  • One-on-one discussion
  • Printed materials
  • Resource manual
  • Risk reduction supplies (condoms, lubricant)

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Intervention Package Information

Intervention Package Information
An intervention package is not available at this time.  Please contact Scott D. Rhodes, PhD, Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Blvd., Winston-Salem NC  27157-1063, email: srhodes@wfubmc.edu, for details on intervention materials.

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Evaluation Study and Results

The original evaluation was conducted in rural central North Carolina between 2003 and 2007.

Key Intervention Effects

  • Increased consistent condom use

Study Sample
The analytic study sample of 222 men from 30 randomly selected soccer teams is characterized by the following:

  • 100% Latino (61% originally from Mexico; 14% from El Salvador; 7% from Guatemala; 6% from Honduras; 6% from other areas; 2% from Colombia)
  • 100% Male
  • 100% heterosexual
  • Mean age of 30, range 18-71 years
  • 53% completed 8 or fewer years of education
  • Mean length of time in the U.S. = 9 years

Recruitment Settings
Local soccer teams in rural central North Carolina

Eligibility Criteria

  • Teams were eligible if they belonged to Liga Hispana de Fútbol de North Carolina.
  • Participants were eligible to be trained as Navegantes if they were nominated by teammates as having lay health advisor characteristics (good judgment, sound advice, caring listener, and discreet), self-identified as Latino or Hispanic, worked as migrant or seasonal farm workers, were members of North Carolina Hispanic Soccer League, were 18 years of age or older, and had some Spanish language literacy. 
  • Teammates were eligible for assessment if they self-identified as Latino or Hispanic and were 18 years of age or older.

Assignment Method
Of the 89 soccer teams in the multi-county soccer league, 15 teams were randomly selected from the southern region to comprise the intervention group and 15 teams were randomly selected from the northern region to comprise the comparison group.  One person from each team was selected to be trained as a Navegante from those nominated and ranked by team members.  Teammates were randomly selected from each team (114 from control teams and 108 from intervention teams) to participate in the follow-up assessment.

Comparison Group
Wait list control

Relevant Outcomes Measured and Assessment Time 

  • Sex behavior (including consistent condom use in past 30 days) was measured at 18-months post-Navegante training

Participant Retention

  • HoMBReS Intervention:

81%* retained at 18 months post-Navegante training

  • Wait list Control:

80%* retained at 18 months post-Navegante training

Significant Findings
  • Intervention teammates were more likely than comparison teammates to report consistent condom use (always used a condom for vaginal sex)* in past 30 days at 18-months post-Navegante training (OR = 2.3, 95% CI = 1.2, 4.3, p = .01).

Considerations

  • The intervention fails to meet the best-evidence criteria due to not adjusting for cluster assignment of regions to the study arms.
  • Teammates in the intervention soccer teams were also significantly more likely to report HIV testing  than teammates in the wait list control soccer teams at 18-months post-Navegante training (OR = 2.5, 95% CI = 1.5, 4.3, p = .001).
  • All participants were self-identified as heterosexual; however, 6 participants (3%) reported having had sex with men in the past year.
  • Although the soccer teams were not independently randomized to the study groups, all participants were from similar rural communities, and within the Northern and Southern regions, each team was randomly selected for study inclusion. In addition, there were no differences identified between intervention and comparison groups at baseline on a variety of variables including: age, country of origin, educational attainment, and accompaniment status, income, amount of money sent home, employment status, HIV and STI knowledge, sexual behaviors, masculinity and acculturation.*
  • A four-session small group intervention adapted from HOMBRES was tested in a randomized control trial against a cancer prevention comparison group to increase condom use and HIV testing among heterosexual active immigrant Latino men.
    • At the 3-month assessment, intervention participants reported significantly higher consistent condom use with all partners during vaginal/anal sex than comparison participants (AOR=3.52, 95%CI=1.29, 9.63, baseline adjusted; AOR=11.2, 95% CI=1.07, 6.34, BL & covariates adjusted). *
    • However, this finding did not meet PRS Best or Good Evidence criteria because missing data beyond attrition for the consistent condom use outcome exceeded 20%. *

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References and Contact Information

  • Rhodes, S. D., Hergenrather, K. C., Bloom, F. R., Leichliter, J. S., & Montaño, J. (2009). Outcomes from a community-based, participatory lay health adviser HIV/STD prevention intervention for recently arrived immigrant Latino men in rural North Carolina. AIDS Education and Prevention, 21, 103-108.
  • Knipper, E., Rhodes, S. D., Lindstrom, K., Bloom, F. R., Leichliter, J. S., & Montano, J. (2007). Condom use among heterosexual immigrant latino men in the southeastern United States. AIDS Education and Prevention, 19, 436-447.
  • Rhodes, S. D., Hergenrather, K. C., Montano, J., Remnitz, I. M., Romiro, A., Bloom, F. R.,… Bowden, W. P. (2006). Using community-based participatory research to develop an intervention to reduce HIV and STD infections among Latino men. AIDS Education and Prevention, 18, 375-389.
  • Rhodes, S. D., McCoy, T. P., Vissman, A. T., DiClemente, R. J., Duck, S., Hergenrather, K. C., Foley, K. L., Alonzo, J., Bloom, F. R., Eng, E. (2011). A randomized controlled trial of a culturally congruent intervention to increase condom use and HIV testing among heterosexually active immigrant Latino men. AIDS and Behavior, 15, 1764-1775. [adaptation; see considerations]

Researcher: Scott D. Rhodes, PhD, MPH, CHES
Department of Social Sciences and Health Policy,
Division of Public Health Sciences
Wake Forest University School of Medicine, Medical Center Blvd.
Winston-Salem, NC 27157-1063
email: srhodes@wfubmc.edu

*Information obtained from author

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