rhonda bohs, ph. d spectrum programs inc. miami behavioral health center
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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
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