Developing a culturally-sensitive HIV prevention intervention for severely mentally ill Puerto Rican women

Background: Persons with severe mental illness are at increased risk of HIV infection. Among Latinos, Puerto Ricans appear to have the highest rates of HIV and HIV risk. Most commonly applied interventions for severely mentally ill persons are frequently premised on social cognitive theory and do not consider or integrate cultural elements, which may be critical to HIV prevention efforts among minority persons with severe mental illness. Methods: We conducted a study to understand the context of HIV risk among 75 women of PR ethnicity from northeastern Ohio, 15 women of Mexican ethnicity from San Diego County, and 50 women of Mexican ethnicity from northeastern Ohio. Over a two-year period we interviewed a) participants, b) participants' “Critical Other,” and c) participant-identified key informants in their provider network. Additionally, shadowed data with participants were collected for up 100 hours over a 2 year period. Results: Almost one-half of the women (46.3%) regularly listened to music. Four distinct themes emerged from the interviews and shadowing: the importance of music, the use of music to reflect emotion, the use of music to change energy level or thought pattern, and the type of music that was preferred. Conclusion: Data analysis suggests that the acceptability and feasibility of an HIV prevention intervention for mentally ill PR women would be enhanced by the inclusion of key cultural values, religion and spirituality, and by the integration of culturally appropriate music with HIV-relevant lyrics (mental illness, partner violence, drugs) into the delivery of the intervention.