Efficacy of a Family-Based Intervention for HIV Prevention with Hispanic Adolescents with Same Gender Sexual Behaviors

Familias con Orgullo: Pilot Study of a Family Intervention for Latinx Sexual Minority Youth to Prevent Drug Use, Sexual Risk Behavior, and Depressive Symptoms

Families are key in the healthy development of Latinx sexual minority youth (Latinx SMY), a group that experiences behavioral, mental, and sexual health disparities. Despite this, there are no family-based interventions for Latinx SMY and their families to prevent drug use, sexual risk behaviors, and depressive symptoms. The purpose of this pilot study was to evaluate the preliminary impact (i.e., estimated effect sizes) of Familias con Orgullo (FcO) and examine its feasibility and acceptability among 30 Latinx SMY and their parents. Parents and adolescents were randomized to FcO or a control condition and assessed pre/post-intervention. Feasibility was measured based on session completion and effect sizes. Focus groups were conducted to evaluate intervention acceptability. Findings showed promising effects favoring FcO on parent-adolescent communication (d = 0.46) and parental involvement (d = 0.34). There were also promising effects favoring FcO on suicidal thoughts (OR = 0.75) and depression symptoms (OR = 0.69). Finally, 100% of the adolescents in FcO either continued to remain drug-free or transitioned from current use to no use (from baseline to post-intervention) compared to 74% in the control. Effect sizes for condomless sex, parental monitoring, and positive parenting were small. Session completion (above 80%) and focus group findings indicated strong feasibility and acceptability. FcO holds promise for reducing drug use and depressive symptoms and improving family functioning among Latinx SMY.

A Pilot Study of a Sibling-Based Online Intervention to Increase PrEP Uptake and Willingness Among Latino MSM

This study explored the feasibility and acceptability of Entre Herman@s, a novel sibling-based intervention designed to engage siblings to increase PrEP utilization among Latino men who have sex with men (LMSM). Siblings were trained in rudimentary motivational interviewing skills to uncover, evoke, and strengthen their brother's motivation to use PrEP, using the constructs of the Information-Motivation-Behavioral Skills (IMB) model for health behavior change. This pilot demonstrated high feasibility, meeting recruitment, retention, and intervention completion targets. Of the 23 LMSM enrolled, 16 (70%) commenced PrEP, with 12 (75%) continuing at the 3-month follow-up. Initially, 15 participants (65%) were open to PrEP, with 9 (39%) ready to start within the next month. Those who began PrEP use reported a significantly higher degree of closeness to their siblings (p = .019) than those who did not. All LMSMs affirmed that their decision to use PrEP was influenced to some degree by their sibling.

A Mixed Methods Investigation Examining the PrEP Cascade Among 13-18-Year-Old Latino Adolescent Sexual Minority Men

Latino adolescent sexual minority men (ASMM) are at high risk of HIV. Limited research has explored the impact of parent-adolescent communication and beliefs on PrEP adoption among Latino ASMM. Our objective was to examine how parental support and beliefs influence decisions regarding PrEP use. We analyzed PrEP-related attitudes and behaviors within a national cohort of 524 Latino ASMM aged 13-18. Out of the participants, 60.5% were suitable for PrEP. Among them, 59.7% were in the precontemplation stage (stage 1), indicating a lack of willingness or belief of unsuitability. However, 86.4% moved to reach the contemplation stage (stage 2), demonstrating willingness and suitability for PrEP. Only 16.8% moved on to the PrEParation stage (stage 3), indicating their intention to start using PrEP. Furthermore, 4.3% progressed to the PrEP action stage and initiation (stage 4), signifying they had received a prescription, and all reported high adherence (stage 5). Factors associated with reaching later stages included older age, parental support of sexual orientation, and previous HIV/STI testing. The qualitative findings revealed diverse attitudes towards parental involvement in PrEP care among Latino ASMM, including positive, negative, and ambivalent perspectives. Notably, Spanish-speaking participants expressed specific barriers to PrEP communication between ASMM and their parents. Given that parental support and attitudes emerged as significant factors in both our quantitative and qualitative findings, it is evident that public health approaches aiming to disseminate education and awareness about PrEP to parents and families could alleviate the burden on adolescents to educate their parents and enhance support.

Family-based interventions in youth to prevent HIV/AIDS: A systematic review

Parents are primary sex educators of their teenagers and also function as resources for advice and information about sexual decision-making and partner selection. So far, various family-based programs were carried out to prevent HIV infection in young people; however, their findings are contradictory and inconclusive. Therefore, we carried out the current systematic review to critically review the available literature regarding the role of family-based interventions among young people to prevent HIV infection. The available online databases including ISI Web of Science, Scopus, and PubMed were searched systematically up to November 2022. The risk of bias in the eligible studies was examined by two independent authors using the Cochrane Collaboration Risk of Bias tool. A total of 7 studies including 4952 participants were enrolled in the current study. They were conducted between 2006 and 2020. On the basis of the available literature, family-based HIV prevention interventions seem to be effective in terms of improving HIV/AIDS knowledge and also parent-youth communication. It seems that family-based interventions in youth to prevent HIV/AIDS are effective; however, further well-designed studies are needed to help the researchers reach a firm conclusion on this issue. The current systematic review may be used by investigators for future studies in terms of settings and the selection of educational approaches. Moreover, it strongly suggested that further studies investigating the role of family-based education in the prevention of HIV/AIDS utilize more sample size and also a more robust educational framework.

Measurement Invariance of Family Functioning Among Latina/o/x Sexual Minority Youth and Heterosexual Latina/o/x Youth

Positive family functioning is negatively associated with drug use, sexual risk behaviors, and depression; however, existing measures of family functioning were not specifically developed for Latina/o/x sexual minority youth (LSMY). This study examined the factor structure of family functioning and whether it is invariant across sexual orientation (i.e., LSMY and heterosexual Latina/o/x youth). Participants included 454 Latina/o/x youth (LSMY: n = 115, 25.3%). Results yielded a higher-order family functioning factor consisting of parental involvement, positive parenting, parent-adolescent communication, and parental monitoring. The model fit for the sample was acceptable (CFI/RMSEA = .91/.04) and configural invariance indicated that the model fit the data adequately in both groups (CFI/RMSEA = .87/.05). Fit of the metric invariance model (∆χ2 (42) = 54.83, p = .09, ΔCFI, ΔRMSEA, ΔTLI < .001) was not significantly worse than the configural model, however, the scalar invariance model (∆χ2 (42) = 80.18, p < .001, ΔCFI = .01, ΔRMSEA, ΔTLI < .001) was significantly worse than the less constrained models, suggesting that family functioning was noninvariant with regard to sexual orientation. Noninvariance may be related to the unique experiences of LSMY related to sexual orientation that are not captured in existing measures of family functioning.

Trajectories of Drug Use and Depressive Symptoms among Latinx Youth and Sexual Minority Youth

Drug use and depression co-occur and disproportionately affect Latinx sexual minority youth relative to their heterosexual Latinx peers. However, heterogeneity in co-occurring patterns of drug use and depressive symptoms is unknown. The objective of the current study was to identify patterns of drug use and depressive symptom trajectories and examine how these patterns varied between Latinx sexual minority youth and Latinx non-sexual minority youth. Latent class trajectory analysis identified distinct patterns of drug use and depressive symptom trajectories among 231 Latinx adolescents (Latinx sexual minority youth: n = 46, 21.4%; Latinx non-sexual minority youth: n = 169, 78.6%). After identifying class mean trajectories, we examined differences in mean trajectories across groups. A 3-class model was selected as the optimal class trajectory model for both groups, yet classes and trajectories differed. There were differences in initial levels of depression and drug use trajectories between both groups, as well as differences in patterns of drug use trajectories between both groups in two of the three classes. Given the variation in trajectory patterns, there is a need for practitioners to consider the unique needs of both groups to inform the development of preventive interventions for these two populations.

Barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide: a systematic review

BACKGROUND

Interventions aimed at reducing risky sexual behavior are considered an important strategy for averting Human Immunodeficiency Virus (HIV) infection among youth (15-24 years) who continue to be at risk of the disease. Enhancing intervention success requires a comprehensive understanding of the barriers and facilitators to interventions targeting youth. However, there is lack of a systematic review of both quantitative and qualitative studies to comprehensively identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth worldwide. This review aimed to identify and synthesize barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth globally based on original peer-reviewed studies published in the last decade.

METHODS

The Joanna Briggs Institute approach for mixed methods systematic reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to guide this review. Nine electronic databases, Joint United Nations Programme on HIV/AIDS and World Health Organization websites, and reference lists of included studies and systematic reviews on barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth were searched for eligible articles. Studies that met the inclusion criteria underwent quality appraisal and data extraction. Findings were analyzed using thematic synthesis and underpinned by Nilsen, 2015's Determinant Framework.

RESULTS

Overall 13 studies comprising of eight qualitative studies, four quantitative studies and one mixed methods study were included in the review. Several barriers and facilitators across the five Determinant Framework domains were identified. Most of the barriers fell under the characteristics of the context domain (e.g., gender-biased norms). The next important group of barriers emerged within the characteristics of the end users domain (e.g., fear of relationship breakdown). In terms of facilitators, the majority fell under the characteristics of the strategy of facilitating implementation domain (e.g., implementation of intervention with fidelity) and characteristics of the end users domain (e.g., fear of pregnancy or sexually transmitted infections). The next common set of facilitators appeared within the characteristics of the context domain (e.g., family support).

CONCLUSION

This review identified several multi-level barriers and facilitators to HIV prevention interventions for reducing risky sexual behavior among youth. Multi-level and combination approaches are needed to address these factors and enhance intervention success.