HoMBReS

Evidence-level

Effective (About evidence-level criteria)

Description

The rate of HIV and other sexually transmitted diseases (STDs) among Latinos is high compared to non-Latino white people in the U.S. According to the Centers for Disease Control and Prevention (CDC), Hispanics/Latinos – 18.4% of the total U.S. population in 2019 – made up 29% of new HIV diagnoses in that year.

An ongoing North Carolina community-based participatory research (CBPR) partnership developed HoMBReS (Hombres Manteniendo Bienestar y Relaciones Saludables – "Men Maintaining Wellness and Healthy Relationships" in English) and its refined version, HoMBReS Por un Cambio, to reduce the risk of HIV/STDs among immigrant Latino men. Several community stakeholders joined the partnership and were included in the process of research for both interventions, including:

• Assessment
• Objective and activity development
• Intervention design and revision
• Data collection
• Implementation
• Dissemination

HoMBReS and HoMBReS Por un Cambio are delivered through Latino recreational soccer leagues. Each team elects a "Navegante" (Navigator) who is trained to serve as a lay health advisor. Navegantes are selected based on their demonstrated judgment and reputation within the community. Navegantes receive 16 hours of training over four sessions, held during two consecutive weekends. Navegantes serve within their teams to do the following:

• Instruct teammates on effective condom use, HIV testing, and HIV/STD prevention strategies
• Provide leadership and work to shift attitudes on sexual health
• Advocate for change by communicating with health service agencies

Once trained, Navegantes convene monthly to report on their progress, exchange ideas, and plan and coordinate future activities.

Services offered

Navegantes arrange team meetings before or after practices. Some of the topics they address during team meetings include:

• Symptoms of and treatments for HIV and STDs
• Social norms, such as what it means to be a man
• Social justice
• HIV/STD prevention strategies
• Clarification on sexual health facts versus myths
• What to expect when getting tested for HIV and STDs
• Available community resources

Navegantes are provided with a reference resource manual with supplemental materials. In addition, Navegantes are given a satchel with sexual health supplies like condoms and informational brochures about STDs.

Navegantes receive a stipend ($50 per month) after fulfilling their roles.

View this brief video, HoMBReS Prevent HIV, to learn more about the challenges, outcomes, and the use of a community-based approach for program design and implementation.

Results

Intervention team players reported that HIV testing increased to over 60%, while control team players reported an HIV test rate of 40% (eighteen months after Navegante training).

Approximately 66% of intervention team members reported using condoms on a regular basis, compared to over 40% of control team players.

For more information on the program and its results:

Tools of Change

Rhodes, S.D., Leichliter, J.S., Sun, C.J., & Bloom, F.R. (2016). The HoMBReS and HoMBReS Por un Cambio Interventions to Reduce HIV Disparities among Immigrant Hispanic/Latino Men. Morbidity and Mortality Weekly Report, 65(1), 51-56.

Rhodes, S.D., Daniel, J., Alonzo, J., Vissman, A.T., Duck, S., Downs, M., & Gilbert, P.A. (2012). A Snapshot of How Latino Heterosexual Men Promote Sexual Health within their Social Networks: Process Evaluation Findings from an Efficacious Community-Level Intervention. AIDS Education Prevention, 24(6), 514-26.

Rhodes, S.D., Hergenrather, K.C., Bloom, F.R., Leichliter, J.S., & Montaño, J. (2009). Outcomes from a Community-Based, Participatory Lay Health Adviser HIV/STD Prevention Intervention for Recently Arrived Immigrant Latino Men in Rural North Carolina, USA. AIDS Education and Prevention, 21, 103-08.

Rhodes, S.D., McCoy, T.P., Vissman, A.T., DiClemente, R.J., Duck, S., Hergenrather, K.C., ... & Eng, E. (2011). A Randomized Controlled Trial of a Culturally Congruent Intervention to Increase Condom Use and HIV Testing among Heterosexually Active Immigrant Latino Men. AIDS and Behavior, 15(8), 1764-75. [adaptation; see considerations]

HoMBReS has been adapted and replicated in Indianapolis, Indiana. Learn more about this intervention adaptation:

Martinez, O., Roth, A.M., Kelle, G., Downs, M., & Rhodes, S.D. (2014). Adaptation and Implementation of HoMBReS: A Community-Level, Evidence-Based HIV Behavioral Intervention for Heterosexual Latino Men in the Midwestern United States. AIDS Education and Prevention, 26(1), 68-80.

Replication

Implementation of HoMBReS and HoMBReS Por un Cambio requires a strong and mutually committed relationship with Latino recreational soccer leagues and teams. Establishing trust is important, as participants may have experienced anti-immigrant sentiment.

Because HoMBReS and HoMBReS Por un Cambio were developed through CBPR, you'll need to adjust these models in order to meet your community's specific needs.

These interventions were developed before the recommendations supporting the use of pre-exposure prophylaxis (PrEP). The use of biomedical strategies to prevent HIV infection should be included in the implementation and future evaluation of HoMBReS and HoMBReS Por un Cambio.

The role of the Navegante is key to the intervention, and it is important to carefully recruit and select Navegantes who meet certain criteria like:

• Respected by teammates
• Comfortable talking about sensitive topics
• Able to be discreet
• Communicates well, in writing and verbally
• Has time to participate and has access to transportation

Contact Information

Scott D. Rhodes, PhD, Professor of Social Sciences and Health Policy
Wake Forest School of Medicine
336.713.5080
srhodes@wakehealth.edu