Designed to reach recently arrived, non-English speaking Latino men in rural North Carolina, Hombres Manteniendo Bienestar y Relaciones Saludables (HoMBRes) was a sexual risk reduction campaign that aimed to reduce cases of HIV and STD infections through increased condom use and increased access to counseling, testing, and treatment services. Led by the North Carolina Community-Based Public Health Initiative and members of Chatham Communities in Action (CCIA), this intervention began by identifying members of the local Latino community and having one-on-one meetings with these community members and Latino-serving organizations to discuss organizational and project goals and community-based participatory research. As a result of these meetings, the partnership expanded over the course of eight months to include representatives from seven key groups in the community: (1) the North Carolina Hispanic Soccer League, (2) a local Latino tienda, (3) a statewide coalition to promote Mexican leadership, (4) two large, Spanish-language churches, (5) a statewide farm worker advocacy group, (6) a statewide farm worker health program, and (7) the local Latino community. All partners worked together to oversee and make decisions about each phase of the research process and helped to collect data from five focus groups that consisted of 50 Latino men in the target population. This work led to the development of an HIV Prevention GRID that included existing intervention themes and strategies, target community demographics, and intervention objectives and was used to guide the adaptation and revision of intervention activities and materials. The two main resources developed for HoMBRes were a training manual to train the lay health officers (known as navegantes) and a resource manual for the navegantes to maintain, refer to, and supplement with information over the course of the intervention. To qualify as a navegante for the program, individuals had to be 18+, Latino or Hispanic, and a member of the North Carolina Hispanic Soccer League. Additionally, they had to have some Spanish-language literacy, to have worked as a migrant or seasonal farm worker, and to have provided informed consent. Individuals selected or nominated for this role were trained to provide STD/HIV prevention education and prevention information, as well as resource referral to their soccer teammates. Thirty teams in the North Carolina Hispanic Soccer League were selected for the HoMBRes program, with 15 teams serving as intervention groups, and 15 serving as control groups. After receiving training on facilitation and building their resource manuals, navegantes led meetings with their team at the soccer fields either before or after practice, working their way through various topics including STDs, their symptoms and treatment, distinguishing facts from misconceptions, identifying and modeling correct prevention strategies, identifying available community resources for treatment, and discussing norms and expectations. The effectiveness of HoMBRes was primarily evaluated through surveys with soccer players on treatment and control teams. Additionally, navegantes were encouraged to keep an activity log detailing the types of interactions they had and with whom. These logs were analyzed monthly for output monitoring and reporting purposes. 65.6% of the players on the intervention teams said they used condoms consistently, while only 41.3% of the players on the control teams said they did so. The baseline average for HIV testing was less than 10% in both the intervention and control teams. Eighteen months after navegantes were trained and began running meetings, testing had increased to more than 60% among players on the intervention teams and to approximately 40% among players on the control teams. Retention of navegantes was very high. In both the intervention and control teams, more than 80% of navegantes were retained as group leaders after the initial 18-month pilot period.
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