Theoretical Mediators of Safer Sex Among Immigrant Latinas: Implications for HIV Risk- Reduction Interventions

Background: Latinas are disproportionately impacted by the HIV epidemic, yet remain an underserved population. Few studies have explored which components of HIV risk-reduction interventions contribute to reducing Latinas' risk behaviors. This study examined changes in self-efficacy for condom use and negotiating safe sex, feelings of power in relationships, and perceived barriers to condom use as possible mediators of immigrant Latinas' condom use. Methods: As part of a randomized controlled trial to assess the efficacy of AMIGAS, an adapted HIV prevention intervention for Latinas, 252 Latinas, 18-35 years of age, completed ACASI assessments at baseline and 3- and 6-months later. Logistic and linear generalized estimating equation (GEE) models were employed to test mediation over the 6-month period. Sobel tests were conducted to assess the significance of the mediated models. Results: AMIGAS participants showed significant improvements on all mediating factors, a greater proportion of condom-protected sex and more consistent condom use in the past 90 days, and lower rates of never using condoms in the 30 days prior to assessments over the entire 6-month follow-up period compared to control group participants. Analysis also indicated that all four factors partially mediated the proportion of condom-protected sex, consistent condom use, and never using a condom. Conclusions: Results suggest that AMIGAS produced significant changes in key factors that contributed to participants' increased condom use at 3- and 6-months post-intervention. These results improve current understanding about intervention components that may reduce risk behaviors among Latinas, and constitute an important step toward more effective HIV prevention programs.