Engaging Homeless Men and Shelter Providers in Adapting an HIV Prevention Evidence Based Intervention

Background and Purpose:

Homeless men are at high HIV risk. Interventions focusing on sexual risk reduction can help prevent HIV among homeless men and their partners. However, currently there are no existing evidence-based HIV prevention interventions (EBIs) developed targeting this high-risk population. Considering the majority of homeless individuals utilize shelter services, it is critical to develop HIV prevention interventions targeting homeless men that can be implemented at shelter settings. Guided by the ADAPT-ITT model, this study engaged homeless men and shelter providers with the goal of adapting an existing HIV prevention EBI to be compatible with homeless men’s needs and shelter providers’ resources.

Methods

This study was conducted at two shelters located at Los Angeles County. The adaptation process involves three major phases. We first conducted 4 focus groups with homeless men (N=30) and 2 focus groups with providers (N=15) to assess perceived HIV intervention needs and intervention preferences. We also completed 4 consensus groups with homeless men (N=31) and 2 consensus groups with providers (N=14) to rank and select one of five EBI’s for adaptation. Finally, an adapted intervention manual was developed and pretested via 2 focus groups with homeless men (N=12) and 2 focus groups with providers (N=15). Homeless men were recruited through posted flyers, and providers were recruited via referrals from collaborating shelter directors.

Content and thematic analysis was conducted to identify themes critical to investigate intervention preferences, select EBI candidates, and identify adaptation directions. Adapted case summary matrices were developed for data analysis to compare and contrast the information gathered in different focus groups and consensus groups.

Findings

Homeless men and providers identified a high need for HIV prevention intervention at shelter settings. However, providers did not perceive delivering HIV prevention services as high priority. Homeless men and providers also expressed a need for interventions that are brief, integrate condom use and negotiation skills training, incorporate substance use risks, and are tailored to individual risks. Five EBI candidates were selected based on these findings. VOICES/VOCES (VOICES), a single session video-based intervention, was selected for further adaptation through consensus groups. Without modifying the core elements of VOICES, based on men’s and providers’ suggestions, a brief HIV knowledge and risk behaviors survey was added to help the intervention better respond to individuals’ risk profiles and enhance men’s perceived vulnerability to HIV risks to create a “teachable moment” to engage men in the later activities. Alcohol and substance use associated with sexual risks was also added to VOICES. Men and providers in the pretesting groups stated the adapted intervention manuals and materials are useful in reducing HIV risks among homeless men and are relevant to homeless men’s experiences.

Conclusion and Implication

Engaging men and providers throughout the intervention adaptation processes can help to formulate consensus on selecting best-fit EBIs, identify directions for intervention modification, and validate the adapted intervention components. This procedure will also increase the likelihood of making the adapted intervention culturally appropriate, sustainable, and effective in new populations and communities, thus reducing disparities in availability of services.