Integration of Biomedical Intervention Strategies and Structural Approaches into a Couple-Based Behavioral HIV/STI Prevention Intervention: Voices of Spanish-Speaking Latino Gay Couples

A combination approach to HIV prevention and treatment requires both structural and evidence-based approaches. Of particular importance is how to tailor a combination approach to subpopulations of MSM at highest risk of HIV acquisition. A purposive stratified sample of 20 couples (n=40) and 10 providers provided insights into how to adapt and integrate biomedical interventions and structural approaches in a couple-based HIV/AIDS behavioral intervention. The adapted intervention, called Latinos en Pareja, integrates behavioral and biomedical intervention strategies and structural approaches to HIV prevention. The majority, 37 of the participants, had no prior knowledge of the following new biomedical interventions: nPEP; PrEP; and HIV self-testing kits.  Once they were introduced to these interventions, all suggested the need to offer them as part of the behavioral intervention. Participants mentioned the need for information and empowerment through knowledge and awareness of these biomedical interventions. Providers suggested the need to address behavioral, social and structural issues, such as language barriers and the promotion of client-centered approaches to increase access to, adaptation of, and adherence to biomedical interventions.  Corroborating what participants suggested, providers agreed that biomedical interventions should be offered after providing information about these tools. Regarding structural approaches, participants identified structural stigma and discrimination as barriers to care; the couple-based approach as ideal to health promotion; documentation status as a barrier to care; and the need to include family topics in the intervention. The study highlights the promise regarding the feasibility of implementing a combination approach to HIV prevention for Latino gay couples.