The HoMBReS por un Cambio Intervention

HoMBReS por un Cambio is an intervention designed by a CBPR partnership to increase HIV and STI prevention behaviors among Spanish-speaking Latinx men. Based on the original HoMBReS intervention, which is included in the CDC Compendium of Evidence-Based Interventions and Best Practices for HIV Prevention (https://www.cdc.gov/hiv/research/interventionresearch/compendium/index.html) as a best-evidence community-level intervention, it harnesses the existing social networks of recreational soccer teams and incorporates community health workers, known as Navegantes. Navegantes are chosen because they are lay, natural helpers to whom other community members turn for advice, emotional support, and tangible aid. With special training in peer navigation and ongoing support, they become sources of reliable HIV and STI information and resources within their existing social networks. The training curriculum is divided into four modules. The first module provides general information about the intervention and the magnitude of HIV and STIs in the Latinx community, “breaks the ice” to help men feel comfortable talking about sex and sexuality, and explores the roles of Navegantes. The second module focuses on learning how to protect oneself and one’s partner. Module 3 focuses on men’s sociocultural experience as men, and how values, norms, attitudes, and expectancies around gender, masculinity, and being a man influence risk and protective behaviors. Module 4 focuses on reviewing information learned, practicing helping relationships among men, and distributing materials used throughout intervention implementation. Each site was to recruit, train, and support eight Navegantes from eight different soccer teams. These eight Navegantes in turn were to work with eight local recreational soccer teams (18–22 teammates each).

While the original HoMBReS intervention was developed, tested, and shown to be effective, using a CBPR approach (Rhodes et al., 2009, 2006), the partnership revised it in five key ways. First, HIV and STI epidemiologic data were updated throughout the curriculum and video vignettes (components of the intervention used to trigger discussions). Second, because members of the partnership concluded that the intervention did not sufficiently address HIV and STI through a social justice lens, content and activities were added that linked HIV and STI disparities among Latinx populations with upstream health inequities. Third, during previous HoMBReS implementation, Navegantes reported that they wanted to use video vignettes, which had been used in their own training, in their work with members of their social networks (Vissman et al., 2009). Three video vignettes were rewritten and produced for broad use within the community. These vignettes included Negociando el Uso del Condón (Negotiating Condom Use); Haciéndose Las Pruebas (Getting Tested); and Viviendo con el VIH (Living With HIV). The vignettes were developed by the CBPR partnership and focused on men’s lived experiences. For example, the Negotiating Condom Use vignette included a man negotiating condom use with a woman who thinks that either he is being unfaithful or he assumes she has HIV or an STI herself. All actors were local Latinx men. The Getting Tested vignette followed the experience of a Latinx man accessing and obtaining screening for HIV and STIs at a public health department. The Living With HIV vignette highlighted the experiences of a local Latinx heterosexual man living with HIV.

Fourth, despite the successes of the HoMBReS intervention, qualitative data collected previously suggested that Navegantes needed more training in having discussions around sex and sexual health (Vissman et al., 2009). Activities were augmented across the Navegante training modules that allowed Navegantes to incrementally practice (as homework) introducing the themes of HIV and STIs in natural settings (e.g., conversations with friends), helping friends (e.g., peer navigation), and addressing common attitudes and beliefs that compromise Latinx men’s health. A temas del mes (theme of the month) component was added. This component was designed to help guide Navegante-led topics and activities each month throughout the 12-month intervention implementation period. For example, in the first month, an inauguration ceremony is held for each Navegante with his team to celebrate his training and affirm his availability to assist his teammates. In subsequent months, Navegantes focused on various topics with their teammates including HIV, chlamydia, gonorrhea, syphilis, and herpes. The final HoMBReS por un Cambio Navegante training curriculum is outlined in Table 1.

Outline of the HoMBReS por un Cambio Intervention Curriculum for Navegantes.

Note. STI = sexually transmitted infection.