Randomized Control Trial for LGBM
Description of Project Model
Latino Gay and Bisexual Men (Many LGBM endure physical abuse, discrimination, verbal abuse, poverty and homophobia because of their sexual orientation (Diaz, Ayala & Bein, 2004). There is increasing curiosity as well in how racism can be related to health issues (Flores & Millett, 2009), which may not be in LGBM's best health interest. LGBM make up one of the most vulnerable groups in the United States when it comes to HIV infection (Arreola, Neilands, & Diaz, 2009) LGBM are four times more likely to contract AIDS than non-Latino Whites (2004). Despite this knowledge, LGBM is still a group that engages in some of the riskiest sexual behavior, which takes a great toll on their health. Moreover, it has been found that the prevalence of childhood sexual abuse is quite high among LGBM and studies have consistently shown "that childhood sexual abuse significantly predicts negative health outcomes including HIV-risk and mental health issues such as depression, suicidal ideation, and substance abuse among adults" (Arreola et al., 2009).
Action Research Question: Objective
Does the establishment of a randomized controlled trial (RCT) and an Assessment Battery result in a reduction of unsafe sex among Latino and gay and bisexual men (LGBM)? This study will aim to evaluate how an RCT and Assessment Battery can help reduce unsafe sex with Latino LGBM.
The goal of the RCT and Assessment Battery will serve as a form of intervention for this group by stressing the importance of using condoms and, when in times of risk, abstaining from sex as a way to prevent health issues.
Main Outcome Measures:
The main outcome will be to have this group report on their condom use, their unprotected sexual intercourse, as well as times that they abstained from what they deemed risky situations.
Randomization procedure (simple randomization), assessment battery consisting of both an interview administered questionnaire and a self-administered paper and pencil survey.
I believe that most of my challenges with this study will be finding a large enough group of LGBM to study. I may have to come up with specific definitions of LGBM as well -- for example, does LGBM include men who are in relationships with women but that sometimes engage in sexual relations with men? Coming up with a clear definition and then finding participants who fit that definition may be a challenge.
The goal of my study is to find out if by conducting a RCT and an Assessment Battery on LGBM it can reduce high-risk sex. The purpose is to focus on questions regarding the frequency of unsafe sex, which will be defined as sex without condoms and sex with high-risk individuals.
The resources I will be using are scholarly journals related to the topic as well as past models that are related to my topic.
My timeframe for doing this is outlined in the project description.
The CDC (2010) reports that gay, bisexual, and other men who have sex with men represent about 2% of the population, yet they are the population most grievously affected by HIV and they are the only group in which new HIV infections have been steadily rising since the early 1990s. Furthermore, among Latino LGBM, the AIDS rate is increasing at a shocking rate. The approximated rate (per 100,000) of AIDS for Latino men (31.3) was approximately three times that for non-Latino White men (Latino AIDS, 2010). LGBM have some of the highest rates of HIV seroprevalence, seroconversion, and unprotected anal intercourse with multiple partners even though there are so many health risks associated with this type of behavior (2010). In a total of five different studies of LGBM in the U.S., Latinos reported the highest rates of unprotected anal intercourse, even when they were compared with men from different ethnic minority groups (2010).
What are the factors that lead to this type of behavior. There are a few social factors that may be partially to blame for this. Poverty, racism, and homophobia all may result in the feeling of social isolation (Latino AIDS, 2010) and this, undoubtedly, leads to a very poor sense of self as well as immense feelings of shame. When these men feel such a lack of self-esteem and a certain amount of powerlessness in society, it leads to behavior that may be risky despite what these men may know about the health hazards (2010). "Risky situations constrain the possibility of choice and the possibility of protecting yourself" (CDC, 2010).
Because of the stigma that is related to having HIV / AIDS as well as homosexuality, in general, there is a major obstacle in the Latino community when it comes to preventions (Latino AIDS, 2010). Intervention methods that are designed to be more educational -- yet are also relatable to the LGBM -- can help to reduce this sort of risky behavior among LGBM. The purpose of this study is to recruit participants who will then be randomized into one of two different RCT groups. One group will focus more on condom use and the second group will focus on abstaining from risky sex.
Twenty-five years after the start of the whole AIDS epidemic, Latino gay and bisexual men (LGBM) are still severely affected by HIV / AIDS (Ramirez-Valles, Garcia, Campbell, Diaz, Heckathorn 2008). Thought Latinos only represent about 14% of the population in the United States, they account for about 18% of new HIV / AIDS cases (2008). Furthermore, among young men who are having sex with other men, HIV prevalence is twice as high among Latinos (6.9%) as among Whites (3.3%) (2008).
LGBM are subject to discrimination, homophobia and HIV-related stigma that obstruct efforts to combat HIV disease among LGBM (Brooks, Etzel, Hinojos, Henry, & Perez 2005). This stigma is a challenge that is continuous and it prevents the efforts of community, national, and global levels of help with the HIV / AIDS epidemic (2005). One of the biggest consequences of HIV-related stigma and discrimination is the negative effects that it has on individuals who need help as well as prevention efforts, in general. This is because there are social forces at work that prevent people with HIV to get tested, utilize programs that can help, and become educated about how to protect oneself and others from the spread of HIV / AIDS. Because of the social stigma as well, HIV-infected LGBM may not disclose the fact that they have HIV to sexual partners, which puts others at risk of acquiring the disease.
In one study in the United States, 59% of men who had never been tested for HIV stated that one of the main reasons for not seeking testing was because of the social stigma that goes along with HIV (Brooks et al. 2005). The social stigma can also prevent LGBM from getting the help that they need once diagnosed with HIV / AIDS. One survey stated that the American Civil Liberties Union (ACLU) fount that people with HIV / AIDS living in the U.S. were denied access to medical treatment, had their privacy violated, and were refused admittance into nursing homes and other residential facilities (2005).
Furthermore, the negative attitude concerning HIV and homosexuality that are found in Latino and African-American communities have added to the lack of participation in HIV prevention services by LGBM (and African-American men as well) (Brooks et al. 2005). The reason that men of color will deny getting tested or getting treatment for HIV is because then they would be admitting that they have engaged in some kind of behavior that is not accepted by their community at large (2005). This is a major challenge because it is thus difficult for researchers to collect sensitive data -- such as sexual risk behavior because it is highly stigmatized (Ramirez-Valles et al. 2008). Using computer assisted self-administered interviews to collect data has been shown to decrease reporting bias, increasing the validity of the variables being assessed (2008).
Zea, Reisen, Poppen, Echeverry and Bianchi (2004) conducted a study where the rates of disclosure by LGBM to members of their social network (mothers, fathers, friends, primary sexual partners, etc.) were examined. A longer time since diagnosis was linked with disclosure to the closet friend. The study shows that there is importance in recognizing certain roles and relationships as they certainly have an effect on disclosure (2004).
The HIV-risk pattern among LGBM has been linked to sexual abuse as well as a social context of discrimination, which, when combined, lead to symptoms of psychological distress (Arreola, Neilands, & Diaz 2009). Guarnero and Flaskerud (2008) note that the Latino community is one that places great value on the family relationships. More traditional Latino families have quite negative views on homosexuality. On this same not, there has been research that has shown that Latino men who have exhibited effeminate behaviors of qualities tend to report high levels of abuse as well as depressive symptoms (2008). This type of negative perceptions can…