Developing a culturally-appropriate HIV intervention in Puerto Rico: Managing stigma and building resilience

HIV continues to disproportionally affect disenfranchised populations. This scenario is aggravated in contexts with poor political commitment to address the HIV epidemic, limited intervention research, and high levels of stigma. In order to respond to these needs and to inform the development of culturally-appropriate intervention to reduce stigma and increase access and retention in HIV care, a participatory mixed-method research and an evidenced-based model for intervention development has been implemented in Puerto Rico (PR). Qualitative interviews have been conducted with healthcare providers (HCP; N=22) and men who have sex with men (MSM; N=30). Similarly, a survey interview has been conducted among HIV+MSM (N=151). The lack of and poor implementation of policies and programs to provide culturally-appropriate interventions in PR are affecting the health of MSM in the island. Multiple negative encounters with HCP and high levels of HIV and gay-related stigma have been reported among HIV+MSM in PR. A pilot assessment of a stigma management intervention among HIV+MSM has evidenced the feasibility of fostering skills and resilience to disclose HIV status and access and engagement in healthcare. The development of interventions to reduce the impact of the HIV epidemic must consider the cultural context where implemented. The use of mixed-methods as well as participatory models is proving to be effective in supporting the needs to develop, implement, and assess the intervention. Policy analyses and actions are needed for the sustainability of the intervention in a setting with limited resources and characterized by high levels of stigma.