Intervention Techniques for the Latino MSM Community

To Keep in Mind:

1. Take the amount of cultural diversity of the Latino community into account. This includes country of origin, if they are foreign-born or U.S.-born, and what ethnic group they are from (for instance, mestizos vs. mulattoes).

2. Keep in mind barriers such as language and level of acculturation. Currently Spanish language materials and interventions are being designed with all this in mind.

3. The best interventions come from the community itself. In particular, Latino MSM identified as desirable interventions that came from within the community. They identified the most effective public health care worker or social worker as a Latino male who understands both their culture and their language. This opens up the possibility of using community volunteers to promote healthier sexual behaviors.

4. Remember the especially tough questions about gay identity, social isolation, and marginalization that affect Latino MSM. Latino MSM often feel left out of their culture, and are unable to talk about their sexual experiences or preferences with their peers. In several studies, Latino MSM saw support groups with other Latino men like themselves as desirable. This does not apply to non-gay identified MSM, however, who preferred one-on-one meetings and were not likely to use public resources or clinics, especially church-sponsored resources or clinics.

Effective interventions have been put into place, mostly by community-based organizations and university-based centers that use local resources and people to support Latino MSM, especially through group or individual counseling. For example, see Raphael Diaz’s book for more information about the Hermanos de Luna y Sol (HLS) program in San Francisco that used a combination of workshops, counseling, recreational activities, and peer support to provide both better social support and information to empower Latino MSM.

For doctors and other healthcare workers, the best intervention could be an in-depth interview.

The Mountain-Plains Regional AIDS Education Training Center developed a useful model for approaching sexual risk assessment modified below. (from GLMA)

1. Assess risk at every new patient visit and when there is evidence
that behavior is changing.

2. Sexual risk assessment should be part of a comprehensive health
risk assessment, including use of seatbelts and firearms, domestic
violence, and substance abuse.

3. Qualify the discussion of sexual health emphasizing that it is a
routine part of the interview and underscore the importance of
understanding sexual behavior in providing quality care. Remind
the patient that your discussion is confidential. You may need to
negotiate what ultimately becomes part of the medical record.
a. "In order to take the best possible care of you I need to
understand in what ways you are sexually active."
b. "Anything we discuss stays in this room."

4. Avoid use of labels like "straight," "gay," or "queer," or terms that
do not relate to specific behaviors. As an example, a significant
percentage of both African-American and Latino MSM identify as
heterosexual, even though they may practice anal intercourse with
other men.

5. Be careful while taking a history, in making assumptions about
behavior based on age, marital status, disability or other
characteristics.

6. Ask specific questions regarding behavior in a direct and nonjudgmental
way.
a. "Are you sexually active?"
b. "Do you have sex with men, women, or both?"
c. Determine the number of partners, the frequency of
condom use, and the type of sexual contact (e.g., oral,
anal, genital).

7. Assess the patient’s history of sexually transmitted infections
(STIs).

8. If the patient’s responses indicate a high level of risk (e.g.,
unprotected sexual activity, significant history of STIs), determine
the context in which these behaviors occur, including concurrent
substance use and mood state.
a. "I want to get an understanding of when you use alcohol or
drugs in relation to sex."
b. "How often are you high or drunk when you’re sexually
active? How does what you do change in that case?"
c. "How often do you feel down or depressed when you’re
sexually active? Do you act differently?"

9. Summarize the patient’s responses at the end of the interview.