HRSA SPNS Program: Culturally Appropriate Interventions for Latino/a Populations – Evaluation and Technical Assistance Center

The demonstration site projects will design, implement and evaluate culturally appropriate service delivery models focused on improving health outcomes among Latinos/as living with HIV disease.  This initiative will take a transnational approach, with demonstration project applicants proposing innovative interventions targeting HIV-affected Latino/a subpopulations living in the U.S. but specific to their country of origin.  The initiative will focus on Latinos/as who are at high risk of HIV infection or are infected with HIV but are unaware of their HIV status; are aware of their HIV infection but have never been engaged in care; are aware but have refused referral to care; or have dropped out of care.  Demonstration project applicants will propose innovative interventions that identify Latinos/as at high risk or living with HIV and improve their access, timely entry and retention in quality HIV primary care.  Latino/a subpopulations of interest include but are not limited to heterosexual men, heterosexual women, gay and bisexual men, bisexual women, transgender women, and/or injecting drug users (IDUs) located in areas with high concentration of Latino/as with high incidence and/or prevalence of HIV/AIDS, especially in urban areas.

The Evaluation and Technical Center (ETAC) will be expected to fulfill three important functions for this SPNS initiative. The ETAC will 1) provide technical assistance to the demonstration projects over the course of the initiative; 2) conduct a rigorous multi-site evaluation of the implementation and outcomes of all interventions and the multi-site cohort as a whole; and 3) lead and coordinate the efforts for publication and dissemination of findings and lessons learned from the initiative.  The ETAC will work in close consultation with the SPNS program in all aspects of the initiative, but especially in the implementation of the multi-site evaluation and dissemination. 

The successful applicant will demonstrate expertise in engagement and retention in HIV primary care.  Applications should include a literature review that demonstrates an in-depth understanding of the Latino/a population and the challenges involved in identifying Latinos/as who are unaware of their HIV status, as well as engaging and retaining those newly diagnosed in HIV primary care.  Applicants should discuss the sociocultural and structural barriers, especially stigma, that affect Latino/as’ access and retention in HIV primary care.  Applicants should also discuss the factors driving HIV incidence and prevalence rates among Latinos/as using the most recent, available data.  Finally, applicants should propose a multi-site evaluation plan that will produce findings that enhance knowledge of the disparities in health outcomes affecting Latino populations living in the United States (U.S.).

According to the 2010 Census, there are 50.5 million people of Hispanic or Latino origin (hereafter cited as Latino/as) living in the U.S.[[]1]  After African-Americans, Latino/as are the most disproportionately impacted racial/ethnic group by the HIV/AIDS epidemic in the U.S.  According to the Centers for Disease Control and Prevention (CDC), an estimated 220,000 Latino/as were living with HIV infection in the U.S. at the end of 2009, with almost 20 percent  unaware of their infection.[[]2]  Although representing 16 percent of the total U.S. population, Latino/as comprised 22 percent of those newly diagnosed with HIV in 2010, with an infection rate almost three times as high as that of whites.[[]3]  By the end of 2009, over 114,000 Latino/as had died from HIV/AIDS since the epidemic began in the U.S.[[]4]

Among Latino/as, men comprised 83 percent of new HIV infections in 2010, with 76 percent of those infections among Men who have Sex with Men (MSM), 11 percent from heterosexual contact and 9 percent from injection drug use.[[]5] Latino MSM comprised nearly two-thirds of all new infections among Latino/as, and comprise the single largest subgroup of Latino people living with HIV/AIDS.[[]6]  Latina women accounted for 21 percent of new infections among Latino/as, with 77 percent of those infections attributed to heterosexual contact and 21 percent to injection drug use.[[]7] Although CDC does not yet report HIV surveillance data for transgender women who are classified as MSM, HIV prevalence among transgender Latinas has been found to range from 14 to 50 percent in 5 studies.[[]8],[[]9],[[]10],[[]11],[[]12]  The CDC’s National HIV Behavioral