Research has shown that sibling support helps Latino LGBTQ+ men take steps to prevent HIV infection

This post was updated on May 21 at 10:29 p.m

Researchers from UCLA and Northwestern University found that sibling support can act as an extrinsic motivation for Latino sexual minority men to take action to prevent HIV infection.

The National Institutes of Health-funded study — titled “Entre Herman@s,” or Between Siblings — was initiated in 2020 by Homero del Pino, an assistant professor in the Department of Psychiatry and Biobehavioral Sciences at the David Geffen School of Medicine at the University of California, Los Angeles. . Del Pino said he was inspired by research on the impact of family rejection on LGBTQ+ people, which made him realize that there is little research on the impact of family reconciliation, particularly among the Latinx LGBTQ+ population.

“Pick any disease, I bet there will be a Latino family intervention for it, including mammogram-seeking behaviors, diabetes management, substance use reduction, physical violence and HIV prevention,” del Pino said. “But when you look at gay Latinos, it’s like you’re crawling out of a rock. The number of family-based HIV prevention programs among Latinos is almost zero.”

As a gay Latino, del Pino said the support he received from his siblings encouraged him to explore the role of sibling dynamics in HIV prevention. The study specifically focused on the use of pre-exposure prophylaxis, or PrEP, because researchers were initially interested in the limits within which heterosexual siblings could discuss using the drug, del Pino added.

PrEP prevents HIV from replicating in the body after exposure, said Dr. Raul Macias Gil, an infectious disease specialist at Harbor-UCLA Medical Center. He added that PrEP can be taken as a daily oral pill or a monthly injection.

However, del Pino said misconceptions about PrEP’s side effects, combined with the belief that taking PrEP means promiscuity, may reduce people’s willingness to use the drug.

Macias Gil said another barrier related to the Latino population is immigration status. He added that he already had an unincorporated patient who had been diagnosed with syphilis and who was at risk for other sexually transmitted infections such as HIV.

“He thought he didn’t qualify for PrEP because he didn’t have legal status in the U.S.,” Macias Gil said. “It’s something that a lot of our patients struggle with. It’s really sad that patients are still afraid to ask for treatment in healthcare.”

“To overcome these barriers, siblings can be a trusted source of a patient’s concerns about treatment,” said Juan Zapata, one of the study’s co-authors and an assistant professor of medical and social sciences at Northwestern University. The more familiar a group is with the treatment, the more likely they are to engage in it, he added.

Del Pino said that in the initial stages of the study, researchers first wanted to observe communication dynamics between 31 pairs of siblings. According to the article, participants discussed their experiences coming out to their siblings, their approach to PrEP and how they have supported each other in the past to change their behavior.

The researchers found that although most of the men they interviewed were aware of PrEP, only 32% were confident about accessing it and 55% were undecided about getting treatment.

Del Pino said other participants reported that their primary care physicians, who did not specialize in infectious diseases or HIV, advised them against taking PrEP. Health care providers’ lack of knowledge about PrEP is another barrier to access, he said.

Nevertheless, when participants were asked whether they would choose PrEP to ease siblings’ concerns about their health, more than 70% said yes, del Pino said.

Six months later, of the 20 siblings who participated in focus groups, eight of them said their brothers had started using PrEP — even though researchers did not actively promote PrEP during the initial interviews in the study, del Pino said. He added that the trend of siblings supporting PrEP continues, as 19 of 20 siblings who participated in focus groups said they would choose PrEP if it encouraged their brothers to do so.

These results led researchers to develop an intervention model in which PrEP is intentionally promoted, as opposed to an initial interview phase, del Pino said.

The researchers also trained the siblings in motivational interviewing, a method that includes open-ended questions, affirmations and summaries to encourage behavior change. For example, if a sibling asked their brother if he would consider PrEP and he replied he could do without it, the sibling would ask another open-ended question, del Pino said.

“My brother might say, ‘I’m fine because I use condoms almost all the time,'” del Pino said. “Then I could say, ‘I see you’re taking positive steps towards taking care of your sexual health. Do you think you can do more?”

Del Pino said the research group is now working to further prove the effectiveness of this intervention in a more formal research study.

Researchers are also examining other family relationships, such as with cousins ​​and mothers, and are creating a control group in which subjects will discuss vaccines to see if there are differences in PrEP group communication, he said.

“In my opinion, this is one of the first studies to examine the dynamics between siblings and LMSM (Latinos who have sex with men),” Zapata said. “PrEP is a wonderful resource that so many people can benefit from.”