Designing and Evaluating an Educational Initiative Promoting Condom Use Among HIV+ Hispanic Men

Background

Hispanics in the United States include a diverse mixture of ethnic groups and cultures. With more than 25 million Hispanics, the U.S. has the fifth-largest Hispanic population in the world, following Mexico, Spain, Argentina, and Colombia (Blanco & Garcia, 2021). Infectious diseases (IDs) (particularly HIV infection) are a severe threat to the Hispanic community residing in the U.S.–especially men. In addition to being a population seriously affected by HIV, Hispanics continue to face challenges in accessing health care, prevention services, and treatment (CDC, 2023b).

Hispanic men (the HIV/AIDS community) continue to encounter difficulties in receiving interactive, culturally sensitive education. Culturally sensitive education to Hispanic men has been vital in identifying the key components to address since the HIV/AIDS epidemic began; specifically, adherence to condom use is imperative when providing health education (CDC, 2023).

Problem Statement

The CDC (2021a) has estimated that between 252,000 and 312,000 Hispanic people in the United States are unaware of their risk of transmitting HIV/AIDS. These statistics indicate that one in five Hispanic persons in the United States is unaware of their HIV infection status and could be spreading the virus to others without knowing they are infected (CDC, 2021a).

The number of people living with HIV/AIDS in a county in a southeastern state has increased by 23% from 2014 to 2022. Hispanics, while they makeup 67% of the county’s general population, represented 51% and 44% of HIV/AIDS cases reported in 2023, respectively. As of January 31, 2024, this county ranks number one in the state of Florida for the number of new HIV cases and AIDS cases. In Florida, of those living with HIV/AIDS, the top transmission rate includes men who have sex with men (MSM) at 43% and heterosexual contact at 34% (Florida Department of Health, 2022).

The writer interviewed HIV-positive Hispanic men residing in a southern area of Florida. Several cultural challenges, such as stigmatism, were revealed by most of the participants, which could contribute to the HIV/AIDS epidemic in Hispanic men. They verbalized resistance to using condoms because “sex is not the same.” This population expressed the desire to receive interactive HIV/AIDS education by Advanced Practice Nurses on appropriate and effective condom use and practices. According to Wilson and Yoshikawa (2020), HIV has a tremendous impact on the Hispanic gay community, as gay men constituted most of the HIV/AIDS cases during the 1980s and early 1990s. As the epidemic has grown and changed, ethnic minority men who have sex with men (MSM) represent the highest proportion of new HIV/AIDS cases in the United States (Wilson & Yoshikawa, 2020).

This educational approach provides substantial information that may assist Hispanic men in enhancing their knowledge regarding effective methods to decrease the spread of sexually transmitted diseases, specifically HIV/AIDS. Extraordinary advances in healthcare, research, and medicine have contributed to the understanding, prevention, and treating HIV/AIDS in the last 50 years (Dieffenbach & Fauci, 2021). Despite these advances, approximately 2.5 million persons are still being infected with HIV/AIDS each year (Dieffenbach & Fauci, 2021). HIV/AIDS-affected communities need to take control of the growing epidemic occurring within their populations (Campbell & Cornish, 2020). Community empowerment helps to increase the likelihood that community members will engage in health-enhancing behavioral changes such as health prevention, health promotion, healthcare, and appropriate health treatments. Healthcare professionals are responsible for developing valuable tools such as culturally sensitive programs that provide HIV/AIDS education to HIV Hispanic males and assist them in changing their behavior and lifestyles, leading to overall improved health.

Purpose Statement and Project Objectives

The purpose of this proposed project is to design and evaluate an HIV/AIDS culturally sensitive educational program for HIV+ Hispanic males at a medical center in South Florida. This proposal outlines a planned intervention to address critical gaps in HIV prevention education.

Goals and Objectives

The goal of this educational project is to design a plan to assess the effectiveness of the health education program to help Hispanic males make changes and improve their knowledge of condom use. The medical center is an outpatient practice located in the southern state. The medical center focuses on primary health care services as well as special health care and preventative services for HIV and Hepatitis for lesbian, gay, bisexual, and transgender (LGBT) patients. The medical center sees 25-30 HIV+ males daily; at least 15-20 of these men are Hispanics.

Recommended components of this implementation plan include group sessions, video viewing, and 1:1 interaction to promote condom use. The objective of this culturally sensitive educational project is to (a) propose system-related health recommendations, (b) translate evidence into practice as it relates to increasing knowledge regarding the effectiveness of wearing condoms, (c) educate patients to self-efficacy and its relationship with decreasing STD’s, specifically, HIV/AIDS; and (d) demonstrate different types of condoms and proper placement.

Significance and Relevance to Practice

To effectively collaborate in decreasing the transmission of HIV/AIDS, timely connection to HIV/AIDS-related care services is imperative as is, providing culturally sensitive education (Garland et al., 2021). Hispanic men are at the highest risk of becoming infected with sexually transmitted diseases (STDs) for a variety of factors such as poor physical health and adverse socioeconomic outcomes, i.e., diminished long-term health, reduced use of healthcare services, and increased personal costs. Perhaps the most studied of these outcomes is human immunodeficiency virus (HIV) infection (CDC, 2023).

In addition, various socioeconomic problems associated with poverty, including limited access to high-quality health care, increase the risk of HIV infection. Recent immigrants face additional challenges, such as a lack of cultural information about HIV/AIDS, which may increase their risk of exposure to the virus (CDC, 2022).

The Hispanic male population possesses a lack of understanding regarding the effectiveness of proper condom use in reducing the spread of STDs, including HIV/AIDS, which is recognized in the literature (Marin, Gomez, & Tschann, 2020). A large proportion of Hispanic men have multiple partners. Therefore, healthcare providers should recommend that Hispanic men carry and use condoms. (Marin et al., 2020). According to the CDC (2012), the majority of HIV/AIDS cases continue to occur among males in the men having sex with men (MSM) category.

DNP-prepared nurses are responsible for advocating for treatment and developing educational projects tailored to different cultures (such as Hispanics), providing evidence-based care for this population, and working with other disciplines to provide cohesive and coordinated care. Primary prevention efforts may focus on culturally sensitive education and individual behavior to decrease the spread of HIV/AIDS. Secondary prevention efforts, the focus of this culturally sensitive educational project, may help limit the morbidity and mortality associated with the HIV/AIDS diagnosis. In addition, it is imperative to connect patients who have HIV/AIDS with high-quality medical care, social services, and other professional services to provide exceptional, comprehensive, community-based care.

The Logic Model

For this educational project, the Logic Model will be used to guide the development of a conceptual approach to describe the activities of the project and the relationships among the activities, the theoretical foundations of the program, and the program’s goals and objectives. Logic models help demonstrate the events for bringing about expected change or results and determine how the program is supposed to work (CDC, 2022). Furthermore, the logic model framework illustrates the medical center’s stakeholders and briefly describes its usefulness in program planning, i.e., what activities the intervention provides and what the intervention intends to achieve, emphasizing the link between the two. For instance, during the 1:1 and focus group sessions, it was recommended to assess the participants’ knowledge regarding the effectiveness of condom use in decreasing the spread of HIV/AIDS, their readiness to learn, and the tools needed to assist them. The author developed an evaluation tool as part of the implementation part to evaluate the participants’ intent and the preparation for consistent and effective condom use.

A logic model, also known as a program model, theory of change, or theory of action, illustrates how a program or intervention is expected to produce desired outcomes. It shows the relationships among the inputs and resources available to create and deliver an intervention, the intervention’s activities, and the expected results (Hodges & Videto, 2021).

A useful logic model identifies the intermediate and ultimate outcomes of the intervention and the pathways through which intervention activities produce those outcomes (Hodges & Videto, 2021). In addition, it shows the interrelationships among intervention components and recognizes the influence of external contextual factors on the intervention’s ability to produce results.

Logic models can guide developing measures of critical intervention inputs, processes, and outcomes. They provide a logical and theory-based structure for identifying measurable and evaluable changes (Livingood, Winterbauer, McCaskill, & Wood, 2019). By laying out the relevant components and inner workings of an intervention (the proverbial “black box”), a logic model serves as a road map for data collection, aiding in decisions about the critical aspects of the intervention that merit evaluation and ensuring that evaluators identify indicators of all elements critical to the intervention theory. According to Hodges and Videto (2021), logic models help evaluators identify the critical questions to be answered and guide evaluation priorities and allocation of resources. Designing data collection to align with a logic model allows evaluators to examine and test the intervention logic. It explains the hypothesized causal mechanisms if desired outcomes are attained (Hodges & Videto, 2021). If an intervention does not achieve desired outcomes, an evaluation firmly based on the intervention’s logic model will help reveal why. For example, tracking outputs can help evaluators determine whether ineffectiveness is the result of (a) insufficient inputs or other implementation challenges or (b) other issues such as unavoidable external factors or incorrect logic (if the intervention was implemented with fidelity but did not have the intended effects) (Livingood et al., 2019).

According to Livingood, Winterbauer, McCaskill, and Wood (2019), a logic model can help intervention planners reach a consensus about their goals and uncover gaps in the intervention logic. Considering these issues at the outset of intervention development enables planners to further specify or modify resources and activities before full-scale implementation. For example, planners might address questions such as: Does a PCMH intervention to increase access contain sufficient communication with patients about newly available after-hours care? Hence, they begin to use this care. Does an intervention to improve chronic care visit pre-planning remind practice staff to review the patient’s record and order needed tests before the scheduled visit? (Livingood et al., 2019).

A logic model provides a critical framework for evaluators (and implementers) to monitor operations and track how the intervention evolves. Tracking indicators for each step in the logic model helps determine whether resources are sufficient and whether activities are implemented according to plan. This process identifies areas for program refinement, mid-course corrections, and technical assistance to support ongoing implementation. For example, the logic model may posit that providers will use health information technology to document patient interactions during office visits, while evaluation data may show that some providers are unable to do so effectively because they do not fully understand how to use the new software; thus, highlighting a need for additional provider training (Hodges & Videto, 2021).

Conclusion and Future Directions

This proposed research initiative represents a significant opportunity to address critical gaps in HIV/AIDS education for Hispanic males. By combining rigorous scientific methodology with culturally sensitive approaches, the project seeks to make meaningful contributions to public health strategies targeting infectious disease prevention.

References

Blanco, F., & Garcia, T. (2021). First-line therapy and mitochondrial damage. Different nucleosides, different findings HVI Clinical Trials, 4, 11-19.

Campbell, C., & Cornish, F. (2020). Community mobilization supplementary issue towards a “forth generation” of approaches to HIV/AIDS management: Creating contexts for effective community mobilization. AIDS Care, 22(2), 1569-1579.

Centers for Disease Control & Prevention. (2022). Evaluating working groups. Retrieved from http://www.cdcgov/eval/steps.htm

Centers for Disease Control & Prevention. (2023). Retrieved from: http://www.cdc.gov/

Centers for Disease Control & Prevention. (2023b). Condoms and their use in preventing HIV infection and other STDs , Atlanta, GA.

Centers for Disease Control & Prevention. (2019a). Male Latex Condoms and Sexually Transmitted Diseases , Atlanta, GA.

Dieffenbach, C. W., & Fauci, A. S. (2021). Thirty Years of HIV and AIDS: Future Challenges and Opportunities. Medicine and Public Issues, 154(11), 766-770.

Florida Department of Health. (2022). HIV/AIDS Surveillance, Monthly Surveillance Reports, February 2014. Retrieved from: http://www.floridahealth.gov/%5C/diseases-and conditions/aids/surveillance/_documents/msr/2014-msr/MSR0214.pdf

Garland, P. M., Valverde, E. E., Fagan, J., Beer, L., Sanders, C., Hillman, D., Brady, K, Courogen, M., & Bertolli, J. (2021). HIV counseling, testing and referral experiences of persons diagnosed with HIV who have never entered HIV medical care. AIDS Education and Prevention, 23(3): 117-127.

Hodges, B. C., & Videto, D. M. (2021). Assessment and planning in health programs. Jones & Bartlett: Sudbury, MA. Retrieved from https://books.google.com/books?hl=en&lr=&id=R_5QApuIqkcC&oi=fnd&pg=PR1&dq=Hodges+%26+Videto,+2011+logic+model&ots=PLiw1tWRbE&sig=_iV-d5Szo_U3KZb24OBoGiRqO2c#v=onepage&q&f=false

Livingood, W. C., Winterbauer, N. L., McCaskill, Q., & Wood, D. (2019). Evaluating medical home constructs for children with special needs: integrating theory and logic models. Family Community Health, 30(5), 1-15.

Marin, B., & Gomez, C., & Tschann, J. (2020). Condom use among Hispanic men with secondary female sexual partners. Retrieved from http://www.researchgate.net/ publication/14933052_Condom_use_among_Hispanic_men

Wilson, P. A., & Yoshikawa, H. (2020). Improving access to health among African-American, Asian Pacific Islander, Latino lesbian, gay, and bisexual populations. The minority health ad health disparities research and education act, 13(21).

Dr. Gilberto Andino, DPN, MS Ed., BSN-RN

Walden University

Dr. Gilberto Andino is a full-time professor and DNP Coordinator at Ana G. Mendez University’s Department of Nursing. After 32 years of dedicated service, he recently retired from the Veterans Administration. With a Doctorate in Nursing Practice from Walden University, he is a leading Infectious Disease researcher specializing in HIV prevention strategies among Hispanic populations. His pioneering research on designing educational initiatives to promote condom use among HIV+ Hispanic men has significant implications for public health interventions. Dr. Andino is an active member of the Hispanic Nurses Association and has been recognized for his contributions to healthcare education and community health.