High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems
- 17 Downloads
Latino immigrants with substance use and mental health problems are at risk for undiagnosed HIV and sexually transmitted infections (STIs). Participants in a randomized control trial were recruited in Boston, USA and Madrid and Barcelona, Spain. Eligibility criteria were Latino self-identification, age 18–70, elevated substance use and mental health symptoms, and not currently in substance or mental health care. A multinomial logistic regression examined predictors of HIV/STI testing decline and lost to follow-up (LTFU) prior to testing compared with acceptance. Of 341 participants, 74% accepted testing, 4% declined, and 22% were LTFU. The odds of LTFU were higher in those with high concern for HIV and those whose main partner had done HIV testing. Age ≥ 35 years, females, higher education, and higher report of discrimination lowered the odds of LTFU. Delivery of HIV/STI testing through community agencies and outreach could overcome barriers to HIV/STI diagnosis in this population of Latinos.
Clinical Trial Number: NCT02038855
KeywordsHIV Sexually transmitted infections Testing Latinos Mental health Substance use
Los inmigrantes de origen latino con problemas de uso de sustancias y salud mental presentan un mayor riesgo de no ser diagnosticados del VIH y de las infecciones de transmisión sexual (ITS). Los participantes de este ensayo aleatorio controlado fueron reclutados en Boston, Estados Unidos y en Madrid y Barcelona, España. Los criterios de elegibilidad incluían autoidentificarse como Latino, tener edad entre 18 y 70 años, síntomas elevados de uso de sustancias y un trastorno psicológico, y no estar recibiendo ningún tratamiento para estas condiciones. Una regresión logística multinomial examinó los predictores de la disminución del test del/las VIH/ITS y pérdida de seguimiento (PDS) antes de ofrecer el test del/las VIH/ITS comparándolo con los que aceptaron realizar el test y mantenerse en tratamiento. De los 341 participantes, un 74% aceptó realizarse las pruebas, un 4% las rechazó, y un 22% fue PDS. La probabilidad de PDS fue mayor en aquellos con alta preocupación por el VIH y en aquellos cuya pareja principal se había realizado el test del VIH. Tener más de ≥ 35 años, ser mujer, alcanzar la educación superior, e indicar un alto nivel de discriminación percibida fueron factores relacionados con la reducción de la probabilidad de PDS. La realización del test del/las VIH/ITS a través de las agencias comunitarias y sus actividades de captación podrían superar las barreras del diagnóstico de VIH/ITS en esta población de Latinos.
The work was supported by the National Institutes Health (National Institute of Mental Health grant K23 MH100978 and National Institute on Drug Abuse grant and supplement R01 DA034952), and a CFAR ADELANTE award funded by the NIH-funded Centers for AIDS Research (P30AI050409 and P30AI117970) and the U.S. National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, Harvard Medical School and its affiliated academic health care centers, or the National Institutes of Health.
All authors have contributed significantly to the work, have seen and approved of this manuscript. Author contributions include formulation of the research question (Levison, Alegría, El-Bassel), design of the analytic plan (Levison, Alegría, Markle, Wang), data collection (Fuentes, Albarracín, Cellerino, Markle, Alegría), data analysis (Wang, Levison, Alegría), manuscript preparation (Levison, Alegría, Markle), and critical editing (Levison, Alegría, Wang, Markle, Mejia, Tarbox, El-Bassel). The contents of this article have not been published, and the paper is not under review elsewhere for publication.
Compliance with Ethical Standards
Conflict of interest
All authors have declared that no competing interests exist.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 1.Dailey AF, Hoots BE, Hall HI, Song R, Hayes D, Fulton P Jr, et al. Vital signs: human immunodeficiency virus testing and diagnosis delays—United States. MMWR Morb Mortal Wkly Rep. 2017;66(47):1300–6.Google Scholar
- 2.Nunez O, Hernando V, Diaz A. Estimating the number of people living with HIV and the undiagnosed fraction in Spain in 2013. AIDS. 2018;32:2573.Google Scholar
- 3.Sapsirisavat V, Phanuphak N, Keadpudsa S, Egan JE, Pussadee K, Klaytong P, et al. Psychosocial and behavioral characteristics of high-risk men who have sex with men (MSM) of unknown HIV positive serostatus in Bangkok, Thailand. AIDS Behav. 2016;20(Suppl 3):386–97.Google Scholar
- 4.Zea MC, Reisen CA, del Rio-Gonzalez AM, Bianchi FT, Ramirez-Valles J, Poppen PJ. HIV prevalence and awareness of positive serostatus among men who have sex with men and transgender women in Bogota, Colombia. Am J Public Health. 2015;105(8):1588–95.Google Scholar
- 5.Reisen CA, Zea MC, Bianchi FT, Poppen PJ. Characteristics of Latino MSM who have sex in public settings. AIDS Care. 2011;23(4):456–9.Google Scholar
- 6.Joint United Nations Program on HIV/AIDS (UNAIDS). 90-90-90 An ambitious treatment target to help end the AIDS epidemic. 2014. http://www.unaids.org/sites/default/files/media_asset/90-90-90_en_0.pdf. Accessed 26 June 2018.
- 7.World Bank. International migrant stock, total. http://data.worldbank.org/indicator/SM.POP.TOTL. Accessed 21 August 2017.
- 8.The World Bank. International migration at all-time high. http://www.worldbank.org/en/news/press-release/2015/12/18/international-migrants-and-remittances-continue-to-grow-as-people-search-for-better-opportunities-new-report-finds. Accessed 25 July 2017.
- 9.Pew Research Center. Statistical portrait of Hispanics in the United States. http://www.pewhispanic.org/2016/04/19/statistical-portrait-of-hispanics-in-the-united-states/. Accessed 17 October 2018.
- 10.Instituto Nacional de Estadística. Estadística del Padrón continuo 01/01/18. http://www.ine.es/dyngs/INEbase/es/operacion.htm?c=Estadistica_C&cid=1254736177012&menu=resultados&secc=1254736195557&idp=1254734710990. Accessed 17 October 2018.
- 11.Poncini, H. La población extranjera en España aumenta por primera vez desde la crisis. El Pais. 2018. https://elpais.com/politica/2018/04/24/actualidad/1524564519_812661.html. Accessed 17 October 2018.
- 12.UNAIDS. HIV prevention among key populations. 2016. http://www.unaids.org/en/resources/presscentre/featurestories/2016/november/20161121_keypops. Accessed 25 July 2017.
- 13.UNAIDS. Country progress report 2016. http://www.unaids.org/en/regionscountries/countries/spain. Accessed 31 Jan 2018.
- 14.Centers for Disease Control. HIV among hispanics/latinos. https://www.cdc.gov/hiv/group/racialethnic/hispaniclatinos/. Accessed 8 March 2018.
- 15.Zhang X, Rhoads N, Rangel MG, Hovell MF, Magis-Rodriguez C, Sipan CL, et al. Understanding the impact of migration on HIV risk: an analysis of Mexican migrants’ sexual practices, partners, and contexts by migration phase. AIDS Behav. 2017;21(3):935–48.Google Scholar
- 16.Weine SM, Kashuba AB. Labor migration and HIV risk: a systematic review of the literature. AIDS Behav. 2012;16(6):1605–21.Google Scholar
- 17.Rhodes SD, McCoy TP. Condom use among immigrant Latino sexual minorities: multilevel analysis after respondent-driven sampling. AIDS Educ Prev. 2015;27(1):27–43.Google Scholar
- 18.Kutner BA, Nelson KM, Simoni JM, Sauceda JA, Wiebe JS. Factors associated with sexual risk of HIV Transmission among hiv-positive latino men who have sex with men on the U.S.-Mexico Border. AIDS Behav. 2017;21(3):923–34.Google Scholar
- 19.Poppen PJ, Reisen CA, Zea MC, Bianchi FT, Echeverry JJ. Predictors of unprotected anal intercourse among HIV-positive Latino gay and bisexual men. AIDS Behav. 2004;8(4):379–89.Google Scholar
- 20.Campbell AN, Tross S, Calsyn DA. Substance use disorders and HIV/AIDS prevention and treatment intervention: research and practice considerations. Soc Work Public Health. 2013;28(3–4):333–48.Google Scholar
- 21.Gray KM, Valverde EE, Tang T, Siddiqi AE, Hall HI. Diagnoses and prevalence of HIV infection among hispanics or latinos—United States, 2008–2013. MMWR Morb Mortal Wkly Rep. 2015;64(39):1097–103.Google Scholar
- 22.Trepka MJ, Fennie KP, Sheehan DM, Lutfi K, Maddox L, Lieb S. Late HIV diagnosis: differences by rural/urban residence, Florida, 2007–2011. AIDS Patient Care STDS. 2014;28(4):188–97.Google Scholar
- 23.Levison JH, Levinson JK, Alegria M. A critical review and commentary on the challenges in engaging HIV-infected latinos in the continuum of HIV care. AIDS Behav. 2018;22(8):2500–12.Google Scholar
- 24.Dennis AM, Wheeler JB, Valera E, Hightow-Weidman L, Napravnik S, Swygard H, et al. HIV risk behaviors and sociodemographic features of HIV-infected Latinos residing in a new Latino settlement area in the Southeastern United States. AIDS Care. 2013;25(10):1298–307.Google Scholar
- 25.Navaza B, Abarca B, Bisoffi F, Pool R, Roura M. Provider-initiated HIV testing for migrants in Spain: a qualitative study with health care workers and foreign-born sexual minorities. PLoS ONE. 2016;11(2):e0150223.Google Scholar
- 26.Hernando V, Arco DA, Alejos B, Monge S, Amato-Gauci AJ, Noori T, et al. HIV infection in migrant populations in the European Union and European Economic Area in 2007–2012: an epidemic on the move. J Acquir Immune Defic Syndr. 2015;70(2):204–11.Google Scholar
- 27.Monge S, Alejos B, Dronda F, Del Romero J, Iribarren JA, Pulido F, et al. Inequalities in HIV disease management and progression in migrants from Latin America and sub-Saharan Africa living in Spain. HIV Med. 2013;14(5):273–83.Google Scholar
- 28.Galvan FH, Bogart LM, Klein DJ, Wagner GJ, Chen YT. Medical mistrust as a key mediator in the association between perceived discrimination and adherence to antiretroviral therapy among HIV-positive Latino men. J Behav Med. 2017;40(5):784–93.Google Scholar
- 29.Gilbert PA, Rhodes SD. HIV testing among immigrant sexual and gender minority Latinos in a US region with little historical Latino presence. AIDS Patient Care STDS. 2013;27(11):628–36.Google Scholar
- 30.Zambrana RE, Cornelius LJ, Boykin SS, Lopez DS. Latinas and HIV/AIDS risk factors: implications for harm reduction strategies. Am J Public Health. 2004;94(7):1152–8.Google Scholar
- 31.Lopez-Quintero C, Shtarkshall R, Neumark YD. Barriers to HIV-testing among Hispanics in the United States: analysis of the National Health Interview Survey, 2000. AIDS Patient Care STDS. 2005;19(10):672–83.Google Scholar
- 32.Kinsler JJ, Lee SJ, Sayles JN, Newman PA, Diamant A, Cunningham W. The impact of acculturation on utilization of HIV prevention services and access to care among an at-risk Hispanic population. J Health Care Poor Underserved. 2009;20(4):996–1011.Google Scholar
- 33.Martinez-Donate AP, Zhang X, Rangel MG, Hovell M, Gonzalez-Fagoaga JE, Magis-Rodriguez C, et al. Does acculturative stress influence immigrant sexual HIV risk and HIV testing behavior? Evidence from a survey of male Mexican migrants. J Racial Ethn Health Disparities. 2017;5:798.Google Scholar
- 34.Jardin C, Garey L, Sharp C, Zvolensky MJ. Acculturative stress and risky sexual behavior: the roles of sexual compulsivity and negative affect. Behav Modif. 2016;40(1–2):97–119.Google Scholar
- 35.Senn TE, Carey MP. HIV testing among individuals with a severe mental illness: review, suggestions for research and clinical implications. Psychol Med. 2009;39:355–63.Google Scholar
- 36.Karamouzian M, Shoveller J, Dong H, Gilbert M, Kerr T, DeBeck K. Perceived devaluation and STI testing uptake among a cohort of street-involved youth in a Canadian setting. Arch Sex Behav. 2017;46(7):2165–72.Google Scholar
- 37.Blank MB, Himelhoch SS, Balaji AB, Metzger DS, Dixon LB, Rose CE, et al. A multisite study of the prevalence of HIV with rapid testing in mental health settings. Am J Public Health. 2014;104(12):2377–84.Google Scholar
- 38.De Leon J, Rendon DM, Baca-Garcia E, Aizpuru F, Gonzalez-Pinto A, Anitua C, et al. Association between smoking and alcohol use in the general population: stable and unstable odds ratios across two years in two different countries. Alcohol Alcohol. 2007;42(3):252–7.Google Scholar
- 39.Baca-Garcia E, Perez-Rodriguez MM, Basurte-Villamor I, Saiz-Ruiz J, Leiva-Murillo JM, de Prado-Cumplido M, et al. Using data mining to explore complex clinical decisions: a study of hospitalization after a suicide attempt. J Clin Psychiatry. 2006;67(7):1124–32.Google Scholar
- 40.Qureshi A, Collazos F. The intercultural and interracial therapeutic relationship: challenges and recommendations. Int Rev Psychiatry. 2011;23(1):10–9.Google Scholar
- 41.Chavez LM, Shrout PE, Wang Y, Collazos F, Carmona R, Alegria M. Evaluation of the AC-OK mental health and substance abuse screening measure in an international sample of Latino immigrants. Drug Alcohol Depend. 2017;180:121–8.Google Scholar
- 42.Cherry AL, Dillon ME. The AC-OK cooccurring screen: reliability, convergent validity, sensitivity, and specificity. J Addict. 2013;2013:573906.Google Scholar
- 43.Paykel ES, Hallowell C, Dressler DM, Shapiro DL, Weissman MM. Treatment of suicide attempters. A descriptive study. Arch Gen Psychiatry. 1974;31(4):487–91.Google Scholar
- 44.Alegria M, Falgas-Bague I, Collazos F, Carmona Camacho R, Lapatin Markle S, Wang Y, et al. Evaluation of the Integrated Intervention for Dual Problems and Early Action Among Latino Immigrants With Co-occurring Mental Health and Substance Misuse Symptoms: A Randomized Clinical Trial. JAMA Netw Open. 2019;2:e186927.Google Scholar
- 45.El-Bassel N, Witte SS, Gilbert L, Wu E, Chang M, Hill J, et al. The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health. 2003;93(6):963–9.Google Scholar
- 46.Kamb ML, Fishbein M, Douglas JM Jr, Rhodes F, Rogers J, Bolan G, et al. Efficacy of risk-reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. Project RESPECT Study Group. JAMA. 1998;280(13):1161–7.Google Scholar
- 47.Kroenke K, Spitzer RL, Williams JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16(9):606–13.Google Scholar
- 48.Spitzer RL, Kroenke K, Williams JB, Lowe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.Google Scholar
- 49.Blevins CA, Weathers FW, Davis MT, Witte TK, Domino JL. The posttraumatic stress disorder checklist for DSM-5 (PCL-5): development and initial psychometric evaluation. J Trauma Stress. 2015;28(6):489–98.Google Scholar
- 50.Yudko E, Lozhkina O, Fouts A. A comprehensive review of the psychometric properties of the drug abuse screening test. J Subst Abuse Treat. 2007;32(2):189–98.Google Scholar
- 51.Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. AUDIT: the alcohol use disorders indentification test: guidelines for use in primary care. 2nd ed. Geneva: World Health Organization, Department of Mental Health and Substance Dependence; 2001.Google Scholar
- 52.Baillie AJ, Mattick RP. The benzodiazepine dependence questionnaire: development, reliability and validity. Br J Psychiatry. 1996;169(3):276–81.Google Scholar
- 53.Schnurr PP, Vieilhauer MJ, Weathers F, Findler M. The brief trauma questionnaire. White River Junction: National Center for PTSD; 1999.Google Scholar
- 54.Schnurr PP, Spiro A III, Vielhauer MJ, Findler MN, Hamblen JL. Trauma in the lives of older men: findings from the normative aging study. J Clin Geropsych. 2002;8:175–87.Google Scholar
- 55.Cervantes RC, Padilla AM, de Snyder NS. The Hispanic stress inventory: a culturally relevant approach to psychosocial assessment. Psychol Assess: J Consult Clin Psychol. 1991;3(3):438.Google Scholar
- 56.Alegria M, Jackson JS, Kessler, RC. Collaborative Psychiatric Epidemiology Surveys (CPES), 2001–2003 [United States]. NCS-R Specific Documentation (ICPSR 20240). Inter-University Consortium for Political and Social Research: Ann Arbor, Michigan. Ann Arbor, MI: Inter-University Consortium for Political and Social Research. 2001. http://www.icpsr.umich.edu/cgibin/file.
- 57.Morris NS, MacLean CD, Chew LD, Littenberg B. The single item literacy screener: evaluation of a brief instrument to identify limited reading ability. BMC Fam Pract. 2006;7:21.Google Scholar
- 58.Williams DR, Yan Y, Jackson JS, Anderson NB. Racial differences in physical and mental health: socio-economic status, stress and discrimination. J Health Psychol. 1997;2(3):335–51.Google Scholar
- 59.Steidel AGL, Contreras JM. A new familism scale for use with latino populations. Hispanic J Behav Sci. 2003;25(3):312–30.Google Scholar
- 60.Cervantes RC, Padilla AM, Amado M, de Snyder NS. Reliability and validity of the hispanic stress inventory. Hispanic J Behav Sci. 1990;12:76–82.Google Scholar
- 61.National Institute of Drug Abuse. Seek, Test, Treat and Retain for Vulnerable Populations: Data Harmonization Measure. 2013. https://www.drugabuse.gov/sites/default/files/sttrfiles/HIV_Risk_BehaviorsV.pdf. Accessed 13 March 2018.
- 62.Fisher JD, Fisher WA, Cornman DH, Amico RK, Bryan A, Friedland GH. Clinician-delivered intervention during routine clinical care reduces unprotected sexual behavior among HIV-infected patients. J Acquir Immune Defic Syndr. 2006;41(1):44–52.Google Scholar
- 63.Jones HE, Berkman ND, Kline TL, Ellerson RM, Browne FA, Poulton W, et al. Initial feasibility of a woman-focused intervention for pregnant African-American women. Int J Pediatr. 2011;2011:389285.Google Scholar
- 64.Haukoos JS, Lyons MS, Lindsell CJ, Hopkins E, Bender B, Rothman RE, et al. Derivation and validation of the denver human immunodeficiency virus (HIV) risk score for targeted HIV screening. Am J Epidemiol. 2012;175(8):838–46.Google Scholar
- 65.Hoenigl M, Weibel N, Mehta SR, Anderson CM, Jenks J, Green N, et al. Development and validation of the San Diego early test score to predict acute and early HIV infection risk in men who have sex with men. Clin Infect Dis. 2015;61(3):468–75.Google Scholar
- 66.Datta SD, Sternberg M, Johnson RE, Berman S, Papp JR, McQuillan G, et al. Gonorrhea and chlamydia in the United States among persons 14 to 39 years of age, 1999 to 2002. Ann Intern Med. 2007;147(2):89–96.Google Scholar
- 67.Hosmer DW, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley; 2000. p. 373.Google Scholar
- 68.Heinze G, Schemper M. A solution to the problem of separation in logistic regression. Stat Med. 2002;21(16):2409–19.Google Scholar
- 69.StataCorp. Stata Statistical Software: Release 14. College Station: StataCorp LP; 2015.Google Scholar
- 70.Evangeli M, Pady K, Wroe AL. Which psychological factors are related to HIV testing? A quantitative systematic review of global studies. AIDS Behav. 2016;20(4):880–918.Google Scholar
- 71.Ford CL, Wallace SP, Newman PA, Lee SJ, Cunningham WE. Belief in AIDS-related conspiracy theories and mistrust in the government: relationship with HIV testing among at-risk older adults. Gerontologist. 2013;53(6):973–84.Google Scholar
- 72.Gu J, Lau JT, Tsui H. Psychological factors in association with uptake of voluntary counselling and testing for HIV among men who have sex with men in Hong Kong. Public Health. 2011;125(5):275–82.Google Scholar
- 73.Flowers P, Knussen C, Li J, McDaid L. Has testing been normalized? An analysis of changes in barriers to HIV testing among men who have sex with men between 2000 and 2010 in Scotland, UK. HIV Med. 2013;14(2):92–8.Google Scholar
- 74.Cordova D, Alers-Rojas F, Lua FM, Bauermeister J, Nurenberg R, Ovadje L, et al. The usability and acceptability of an adolescent mHealth HIV/STI and drug abuse preventive intervention in primary care. Behav Med. 2016;44:1–12.Google Scholar
- 75.Chiu CJ, Young SD. Correlates of requesting home HIV self-testing kits on online social networks among African-American and latino men who have sex with men. AIDS Care. 2016;28(3):289–93.Google Scholar
- 76.Murray A, Gaul Z, Sutton MY, Nanin J. ”We hide…” perceptions of HIV risk among black and Latino MSM in New York City. Am J Mens Health. 2017;12:180.Google Scholar
- 77.Young SD, Daniels J, Chiu CJ, Bolan RK, Flynn RP, Kwok J, et al. Acceptability of using electronic vending machines to deliver oral rapid HIV self-testing kits: a qualitative study. PLoS ONE. 2014;9(7):e103790.Google Scholar
- 78.Pando MA, Dolezal C, Marone RO, Barreda V, Carballo-Dieguez A, Avila MM, et al. High acceptability of rapid HIV self-testing among a diverse sample of MSM from Buenos Aires, Argentina. PLoS ONE. 2017;12(7):e0180361.Google Scholar
- 79.Derose KP, Bogart LM, Kanouse DE, Felton A, Collins DO, Mata MA, et al. An intervention to reduce HIV-related stigma in partnership with African American and Latino churches. AIDS Educ Prev. 2014;26(1):28–42.Google Scholar
- 80.Reisen CA, Zea MC, Bianchi FT, Poppen PJ, del Rio Gonzalez AM, Romero RA, et al. HIV testing among MSM in Bogota, Colombia: the role of structural and individual characteristics. AIDS Educ Prev. 2014;26(4):328–44.Google Scholar
- 81.Holloway IW, Padilla MB, Willner L, Guilamo-Ramos V. Effects of minority stress processes on the mental health of Latino men who have sex with men and women: a qualitative study. Arch Sex Behav. 2015;44(7):2087–97.Google Scholar
- 82.Levison JH, Regan S, Khan I, Freedberg KA. Foreign-born status as a predictor of engagement in HIV care in a large US metropolitan health system. AIDS Care. 2016;29:1–8.Google Scholar
- 83.Poon KK, Dang BN, Davila JA, Hartman C, Giordano TP. Treatment outcomes in undocumented Hispanic immigrants with HIV infection. PLoS ONE. 2013;8(3):e60022.Google Scholar
- 84.Thierfelder C, Weber R, Elzi L, Furrer H, Cavassini M, Calmy A, et al. Participation, characteristics and retention rates of HIV-positive immigrants in the Swiss HIV Cohort Study. HIV Med. 2012;13(2):118–26.Google Scholar
- 85.Branson BM, Handsfield HH, Lampe MA, Janssen RS, Taylor AW, Lyss SB, et al. Revised recommendations for HIV testing of adults, adolescents, and pregnant women in health-care settings. MMWR Recommendations and reports Morbidity and mortality weekly report Recommendations and reports. Centers for Disease Control. 2006;55:1-17.Google Scholar
- 86.Moyer VA, U.S. Preventive Services Task Force. Screening for HIV: U.S. preventive services task force recommendation statement. Ann Intern Med. 2013;159(1):51–60.Google Scholar