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[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC - safer, healthier people.

[Dr. Antonia Novello] HIV prevention with young people is very critically important because it presents many special challenges. Some research programs are dedicated to developing culturally-based behavioral interventions for reducing HIV prevention among Latino youth. And since 1999, researchers from the University of Michigan and the University of Pennsylvania have developed and tested an intervention designed to reduce HIV sexual risks among Latino youth. They call their intervention Cuidate!

[Announcer] University of Michigan – Cuidate for Latino Youth. The Spanish word Cuidate means ‘take care of yourself,’ which is the theme of a culturally-based intervention designed by Dr. Antonia Villaruel at the University of Michigan and Drs. John and Loretta Jemott at the University of Pennsylvania. The Cuidate intervention seeks to reduce HIV sexual risk among Latino youth ages 13 to 18. In today's society, adolescents including Latinos, face many health risks related to sexual behavior, such as unplanned pregnancy and sexually transmitted diseases, including HIV and AIDS. Most Latino youth begin sexual intercourse at a later age than African-American and white youth. However, studies show that Latino youth use condoms less frequently and lack access to culturally and linguistically appropriate HIV prevention materials and services.

The focus of the Cuidate intervention is on behavior and not on sexual orientation. This intervention emphasizes that behavior influences both risk of HIV/AIDS, as well as safety from HIV. Using culturally appropriate themes and approaches, Cuidate helps Latino youth develop knowledge, attitudes, and skills to reduce their risk for HIV. The intervention emphasizes strategies, such as abstinence and condom use, through activities for youth to acquire accurate information about risk and HIV/AIDS, develop attitudes that support safe decision making, build skills to abstain from sex and to use condoms correctly, and reinforce confidence in practicing safer sex.

The three main goals of the intervention are to:

One - influence attitudes, behavioral and normalcy beliefs, and self-efficacy regarding HIV risk-reduction behaviors and specifically abstinence and consistent, correct condom use by incorporating the theme of taking care of one’s self and one’s partner, family, and community. Two - develop necessary skills, including negotiation, refusal of sex, and condom use, needed to engage in abstinence or safer sex, and Three - emphasize how cultural values influence attitudes and beliefs in ways that affect HIV risk-related sexual behaviors.

This intervention increases skills, such as negotiation, related to abstinence and condom use through role-plays and other highly interactive small group participation. Materials include music and videos relevant to the particular youth and their community. The intervention, which involves six one-hour modules delivered over the course of two days, was originally tested in two cities. In Philadelphia, the intervention was conducted in English and Spanish, with more than 500 youth. The intervention was repeated in Monterrey, Mexico, in Spanish only, with more than 800 youth.

Youth in Philadelphia reported fewer incidents of sexual intercourse, fewer sex partners, fewer days of unprotected intercourse, and increased consistent condom use as a result of the program. Among youth who were sexually inexperienced when the study began, those who received the Cuidate intervention reported fewer days of unprotected sex than youth who received a health promotion program.

In Monterrey, Mexico, the majority of youth were sexually inactive, but adolescents in the Cuidate intervention reported greater intentions to use condoms and contraceptives than youths in a health promotion program. Each of these effects continued for 12 months after the program ended. The youth and facilitators at both test sites reported that the program was important, enjoyable, and practical.

Why is this intervention so successful? Results and feedback indicate that the success of Cuidate is largely due to working within Latino cultural values to design and deliver the intervention. This is important, because distinct gender roles that are common among Latinos can lead to different expectations for male and female behavior, especially regarding sexual behavior. For example, the Latino cultural value of machismo dictates that men show power by strength and control in decision-making. The Cuidate intervention emphasizes the view that machismo incorporates caring for and protecting others, by keeping oneself and one's partner safe. Also, the Latino cultural value of marionismo expects women to be faithful to one's partner and devoted to the family, to defer decision-making, including sexual decisions, to men. The Cuidate intervention reinforces loyalty and encourages women to consider condom use and refusal of sex as a means of protecting oneself and one’s family. And Cuidate emphasizes the Latino cultural value of familismo, or familialism, which includes loyalty to and protection of one's family. And it recognizes family as a source of support. And especially important is that this intervention incorporates the concept of respecto, or respect for self and partners by modeling effective communication and negotiation strategies.

[Dr. Raul Romaguera] For more information on the Cuidate Intervention, you may contact Dr. Antonia Villarruel at the University of Michigan School of Nursing at 734-615-9696. An intervention package for Cuidate is currently under development.

For a description of this and other interventions and related materials under development, visit CDC's website for replicating effective programs.

[Announcer] To access the most accurate and relevant health information that affects you, your family and your community, please visit www.cdc.gov.