Exploring Norms and Beliefs Related to AIDS Prevention Among California Hispanic Men.(Statistical Data Included)

A focus-group study gathered qualitative information from Hispanic males in California regarding ethnic factors that might enhance or interfere with AIDS prevention efforts. A predominantly working-class convenience sample of 75 men aged 18-40 participated in seven groups of 10-12 participants each. Three groups were composed of single men, three of married men and one was composed of homosexual and bisexual men. Four groups included only participants born outside the United States; and Spanish was the preferred language in five of the groups. Evaluation of the discussions indicates that while AIDS awareness is high among this population, condom use is sporadic. Few participants knew that someone infected with the human immunodeficiency virus could appear healthy; most believed they could easily determine if a woman is risky by her appearance or social standing. Although many participants thought. HIV could be transmitted through casual contact, the homosexual and bisexual men were more likely to acknowledge that they were at some risk of infection; most of the heterosexual men did not perceive themselves as being at risk, even those who engaged in sex with prostitutes or women they met at bars. The participants had ambivalent attitudes toward women who suggested condom use and were often reluctant to initiate condom use themselves. Religion did not seem to play a major role in the men's attitudes about AIDS, sexuality and condom use. (Family Planning Perspectives, 25:111-117, 1993)

The prevalence of human immunodeficiency virus (HIV) infection and new AIDS cases among Hispanics is increasing dramatically. Among Hispanic heterosexual men in the United States, the cumulative incidence rate of AIDS cases is nine times that among non-Hispanic, white heterosexual men. (1) In a survey of 26 of the larger cities in the country, the U.S. Conference of Mayors found that Hispanics accounted for 18% of diagnosed AIDS cases. (2) In California, the proportion of Hispanics among newly diagnosed AIDS patients increased from 7% in 1982 to 18% in 1991. (3) When California data from the first half of 1991 were compared with data from the first half of 1992, the proportion of new AIDS patients who were Hispanic increased from 17% to 18.5%. (4) Alternative test site reports show that Hispanics have higher HIV seropositivity rates than do non-Hispanic whites. (5) These statistics indicate the need for campaigns to prevent HIV infection among Hispanics.

The use of condoms has been advocated as a major public health strategy to reduce the risk of HIV infection. However, even individuals who know that condoms are effective in reducing the risk of contracting AIDS and other sexually transmitted diseases (STDs), and who are concerned about possible exposure to these diseases, do not necessarily translate this knowledge into practice. (6) While evidence suggests that occasional use of condoms to prevent STD infection is not uncommon, (7) use is inconsistent even among condom users. (8)

Although information sources on AIDS and condom use and the channels for communicating this information to Hispanics have been studied, (9) their effectiveness in promoting condom use is unknown and suspect, given the increasing number of Hispanics diagnosed with HIV infection, AIDS and other STDs.

HIV prevention campaigns that are effective in one community may be ineffective in others. (10) Programs that seek to change risky sexual behaviors and drug use must be adapted to the cultural values of the community, taking into account ethnic factors that may enhance or interfere with efforts. Ethnic groups may differ in social norms, values and preferred media, as well as in language.

One way of exploring how a community's values may affect HIV prevention efforts is to conduct qualitative research using focus groups. Participants in a focus group discuss specific topics with the guidance of a moderator, who leads group interactions to obtain information about community norms and values about an issue, while examining the interaction between group members to elicit more information than might be accessible in individual interviews.

Typically, focus-group members are selected to represent the subgroups that the investigator considers relevant to the concepts being explored. Groups are composed of persons who are homogeneous on the relevant dimensions, primarily to facilitate interaction within the group. Conducting several groups of different compositions may reveal salient differences in norms and values that can generate hypotheses for quantitative investigation.