The HIV/AIDS literature has addressed the impact of normative beliefs on sexual risk behaviors, although more theoretical than empirical work has been conducted in this realm. The beliefs of both men and women about the superiority of men and the importance of men's virility and sexual prowess are thought to be associated with a higher frequency of risky behaviors (Amaro, 2000;Gsmez, 1996;Gupta, 2002). This is a revised application of a proposed study that will adapt, develop and pilot an intervention to promote transformation of normative beliefs and safer sex practices among Puerto Rican men who have sex mostly with women, using the Popular Opinion Leaders (POL) model which has been tested and proven effective in other countries and with diverse populations in the U.S. (Kelly et al., 1997;2007). Specifically, we will evaluate the feasibility and acceptability of two intervention modalities: a revised and adapted version of the standard POL intervention emphasizing HIV risk behavior per se;and an enhanced POL intervention, which emphasizes gender-related prevention messages (POL+G).
The specific aims of the proposed study are to: 1. Translate and adapt the standard POL intervention to target men who have sex mostly with women in Puerto Rico. 2. Develop and pilot an enhanced "POL+G" intervention in which POLs deliver both messages on safer sex and gender roles. 3. Conduct a pilot study to adapt and refine measures to assess variables in the prevention models (based on gender theory and social diffusion theory);4. Test the feasibility of evaluating the efficacy of POL versus POL-G with HIV risk reduction in Puerto Rican men who have sex mostly with women. The proposed study will yield: 1) a revised an adapted version of the standard POL intervention;2) a fully developed POL+G intervention;3) data informing the feasibility and acceptability of the enhanced POL intervention;4) refined recruitment, sampling and randomization procedures;and 5) data regarding the psychometric characteristics of the proposed measures. Data from these outcomes will prepare the research team to conduct a larger randomized trial to compare and evaluate the efficacy of both intervention modalities in reducing sexual risky behavior among Puerto Rican men who have sex mostly with women. The proposed research is innovative because it goes beyond the POL model, as it will not only target the transformation of norms and beliefs regarding safer sex, but it will develop and test the feasibility of an intervention that intends to transform social norms and normative beliefs regarding masculinity and gender imbalance.
The situation regarding the HIV-AIDS epidemic in Puerto Rico needs urgent attention, particularly preventive studies specifically tailored for Latino heterosexual men. By addressing norms and normative beliefs regarding gender and sexuality we expect to incorporate crucial cultural, contextual and community (as well as individual) factors that impinge upon heterosexual men's sexual practices. The study will assess the feasibility and acceptability of an intervention that eventually could evolve into an innovative model for HIV/AIDS preventive interventions for Latino men in the United States.