Peru has a concentrated HIV epidemic, in which 12% of men who have sex with men (MSM) are estimated to be HIV-positive. This situation is similar to the rest of Latin America, where sex between men drives the HIV epidemic. Yet very little research has been conducted to develop HIV prevention interventions for Peruvian or other Latin American MSM. We seek to develop an intervention approach that will be relevant to Peruvian men, but has the potential to be generalized to MSM in other Latin American countries. Therefore, we propose to conduct a three-year study to develop and pilot test a community-level HIV prevention intervention for Peruvian MSM that simultaneously focuses on individual, interpersonal, social, and structural factors affecting men's vulnerability to HIV. Our proposed intervention builds on the theoretical principles of two prevention approaches conducted in the U.S., and the previous work this team has been conducting together in Peru over the past eight years. The first intervention, the Mpowerment Project (MP), a community-level intervention, was developed for young U.S. gay/bisexual men and involves community mobilization and individual and community empowerment. The second intervention, Hermanos de Luna y Sol (HLS), was developed for U.S. Latino gay/bisexual men, and is a small-group intervention that focuses on individual empowerment. Although the MP's and HLS'theoretical principles are relevant to Peruvian MSM, a new culturally appropriate intervention needs to be developed because many of the MP's methods are difficult to use in resource-poor settings and the HLS focuses on issues regarding being immigrants and uses some activities that may not be feasible in Peru.
Aim 1 is to adapt and culturally tailor two evidence-based HIV prevention interventions, the MP and HLS, and create new, additional intervention components to respond to the HIV prevention needs of MSM in Peru.
Aim 1 will be accomplished by developing and maintaining an active, working collaboration with a Community Working Group of Peruvian HIV, gay, transvestite, and human rights activists with community expertise who will provide input into all parts of the intervention and will help develop some of the components.
Aim 2 is to develop a multi-level HIV prevention intervention, Peruanos Diversos Unidos, based on the outcomes of Aim 1, involving small group sessions, community mobilization, and leadership development.
Aim 2 will be accomplished by developing an intervention manual and trainings to implement Peruanos Diversos Unidos, which is a combination of five integrated HIV prevention strategies that focus on individual, social, and structural issues.
Aim 3 will be to conduct a pilot study implementing the intervention and assessing the effect of the intervention on sexual risk behavior among a sample of MSM. To accomplish Aim 3, we will implement Peruanos Diversos Unidos for 9 months, and develop a cohort of 100 MSM that is recruited independently of the intervention. If the intervention proves to be acceptable, feasible, and potentially efficacious, this research group will proceed with an R01 application to assess the efficacy of the intervention in a trial.
In Peru, as well as in the rest of Latin America, sex between men drives the HIV epidemic. Yet very little research has been conducted to develop HIV prevention interventions for Peruvian or other Latin American men who have sex with men. We seek to develop an intervention approach that will be relevant to Peruvian men, but has the potential to be generalized to MSM in other Latin American countries. Therefore, we propose to conduct a three-year study to develop and pilot test a community-level HIV prevention intervention for Peruvian MSM that simultaneously focuses on individual, interpersonal, social, and structural factors affecting men's vulnerability to HIV. Our proposed intervention builds on the theoretical principles of two prevention approaches conducted in the U.S., and the previous work this team has been conducting together in Peru over the past eight years. The new intervention approach we will develop will be based on two HIV prevention interventions that were developed for MSM in the U.S. (the Mpowerment Project and Hermanos de Luna y Sol) that will be substantially adapted so that they are culturally relevant for Peruvian MSM, and we will also develop some new intervention components. Throughout the project we will work closely with a Community Working Group of individuals from the Peruvian Health Ministry, HIV/AIDS organizations, and human rights activists in Peru in order to develop an HIV prevention approach that is culturally relevant and to create an intervention approach that is feasible to be implemented and likely to be sustainable subsequent to the research. We will pilot test the intervention in a community in Peru, and examine if the intervention shows potential efficacy for changing sexual risk behavior, is acceptable by MSM, and if the intervention's methods are feasible. If the intervention proves promising in these regards, we will then write a grant proposal to conduct an experimental trial of it.
| Maiorana, Andres; Kegeles, Susan; Salazar, Ximena et al. (2016) 'Proyecto Orgullo', an HIV prevention, empowerment and community mobilisation intervention for gay men and transgender women in Callao/Lima, Peru. Glob Public Health 11:1076-92 |
