A randomized efficacy trial of Hermanos de Luna y Sol

Rafael Diaz, San Francisco State University; Fernando Gomez-Benitez, Mission Neighborhood Health Center

Latino men who have sex with men (MSM) constitute one of the most vulnerable groups in the US for the transmission of HIV, showing disproportionately high rates of unprotected anal intercourse and HIV infection. However, to date, CDC's compendium of evidence-based interventions includes not a single HIV prevention program that has been specifically developed for and tested with Latino MSM. Hermanos de Luna y Sol (HLS), a program of the Mission Neighborhood Health Center (MNHC), is a peer-led HIV prevention intervention that targets Latino, Spanish-speaking, immigrant gay and bisexual men in the San Francisco Bay Area. The program is based on a population-specific, tested model that links the risk for HIV to socio- cultural oppressive factors such as machismo, homophobia, poverty, racism, forced migration, and sexual silence. These factors lead to social isolation and low self-esteem, which in turn lead to participation in high-risk sexual situations and unsafe sexual behavior. For the last twelve years, the intervention has been very successful in its implementation, perceived impact and behavioral outcomes, but never tested in a rigorous scientific way that includes a control comparison group. In this grant application, we propose to conduct an evaluation with 180 men; 90 of them will be part a comparison group who will be put on a wait list to receive the intervention four months after. The evaluation will examine the effectiveness of the HLS program to change sexual risk behavior and to sustain safer sex behavior over an eight-month period. The proposed design has been discussed at length with administrators and staff at HLS/MNHC, and has been accepted as the design that maximizes scientific evidence while minimizing program disruption. HLS/MNHC has agreed to all the necessary program modifications and enhancements to facilitate the proposed efficacy trial.