La Nueva Generación, a collaborative effort between the César E. Chávez Institute and San Francisco’s Mission Neighborhood Health Center (MNHC) was designed to test the effectiveness of an HIV prevention program that targets low-SES, Spanish-speaking, Latino, immigrant men who have sex with men (MSM) in the San Francisco Bay Area, a population with high and well-documented vulnerability to HIV infection.
The program evaluated, Hermanos de Luna y Sol (HLS), was created in San Francisco in the 1990s Dr. Rafael M. Díaz of Stanford University and later founding Director of the Chávez Institute. HLS was initially funded and developed as a component of a larger CDC grant to MNHC, and later funded by the San Francisco Department of Health (SFDH).
Guided by Dr. Diaz’ research on sociocultural and contextual factors that predict high-risk behavior in this population, the HLS program intervenes in a culturally appropriate manner to reduce the incidence of unprotected anal intercourse through the following four specific aims:
- Provide experiences of social support, social belonging, and enhanced self-esteem in the context of a Latino gay identity and community;
- Promote critical awareness of social and cultural forces (e.g., homophobia, racism, poverty and forced migration) that impact and shape participants’ social and sexual lives;
- Increase participants’ sexual self-knowledge, with particular emphasis on sexual contexts and situations of personal vulnerability that limit participants’ ability to practice safer sex; and,
- Facilitate community involvement and activism to support a sense of increased personal agency and self-efficacy (instead of fatalism and victimization) in response to oppressive social forces in participants’ lives.
Program participants receive HIV prevention services in three major modalities:
- An initial group intervention for new participants, implementing a pre-determined HIV prevention curriculum that promotes a sense of social belonging and critical thinking about the social factors and contextual barriers that compete with safer sex intentions;
- A weekly discussion/support group for graduates of the initial group intervention, aimed at providing ongoing social support and open reflective communication to sustain behavior change over time; and
- Individual risk reduction counseling to address individual prevention needs of those participants whose marked vulnerability to HIV risk -- due perhaps to mental health or substance abuse problems -- merits individual attention.
In addition, the program supports ongoing community involvement through drop-in sessions, bimonthly social “Encuentros” and facilitates members’ participation in social events and activities that promote the rights of Latino immigrants and LGBT individuals.
Over the course of approximately fifteen years, Dr. Díaz conducted qualitative and quantitative evaluations, including pre-post monitoring of behavior change and other behavioral outcomes targeted by the program. The outcome evaluation data show substantive reductions in unprotected anal intercourse and increases in social support and self-esteem that are highly correlated with safer sex practices.
The qualitative data show that participants value HLS as a place where they learn about sexuality and the risks posed by the HIV epidemic, and feel that the program acts as a surrogate family that provides ongoing support to meet the specific challenges of Latino immigrant MSM.
The efficacy of the program was not fully tested in the context of a randomized control trial, however. La Nueva Generación was first funded to bring HLS to the level of an evidence-based intervention (EBI). The U.S. economic crisis that reached its peak in 2009, however, caused funding for this important project to be withdrawn mid-stream, before sufficient data could be collected.