Toward a model of culturally appropriate adaptation of HIV prevention evidence based interventions: From sista to sisterhood/chieh mei ching yi

Background: The prevalence of HIV/AIDS among Asian Americans in the US has grown substantially, especially for women. Between the years 2001-2004, the proportion of HIV/AIDS diagnoses among Asian American females aged 15-39 years increased more than other similar age racial/ethnic groups. Especially at high risk are Asian immigrant women who are sex workers. Yet, there are no evidence-based interventions for this population. CDC has developed a intervention translation model: pre-implementation, implementation, maintenance and evolution, while the RE-AIM model outlines: Reach, Effectiveness, Adoption, Implementation and Maintenance. While these models are useful, there are also particular cultural challenges. Methods: We use qualitative coding of facilitator field notes to identify adaptation and revision phases from Sisters Informing Sisters about Topics on AIDS (SISTA) to a culturally responsive intervention for Chinese monolingual women working in massage parlors. The qualitative data span the adaptation design (2007-2009) through to a recently completed randomized controlled trial (2009-2012). Results: The process consisted of multiple phases: (1) direct translation with revision in delivery, (2) piloting and revision of curriculum and recruitment strategies, (3) initial quasi-experimental results, (4) second stage of revision enabling RCT with 200 women. The pilot testing indicated that some concepts (e.g., assertiveness) were not translatable. The second stage of revision incorporated new elements, such as negotiating as bartering, along with eliminating some core elements (such as assertiveness). Conclusion: Effective adaptation of evidence based interventions for culturally distinct populations with limited evidence based interventions requires a multi-phase, linguistic and cultural translation to effectively transfer HIV prevention.