Viviendo Valiente aims to reduce ethnic disparities in HIV care and outcomes by providing culturally responsive services to the Latino/a community, specifically to people of Mexican descent. It is a multi-level intervention, featuring individual-, group-, and community-level activities, that links people to HIV care, offers HIV education and health literacy in group sessions, and promotes community-level testing for HIV and other sexually transmitted infections (STIs). Developed and implemented by Prism Health North Texas (PHNTX), Viviendo Valiente was evaluated through the Ryan White HIV/AIDS Program (RWHAP) Part F Special Projects of National Significance (SPNS) Culturally Appropriate Interventions of Outreach, Access and Retention Among Latino/a Populations initiative, funded from 2013 through 2019. The evaluation found that Viviendo Valiente had positive impacts on HIV testing, retention in care, viral suppression, and client satisfaction.
Faced with barriers to high-quality care and support services, Latinos are disproportionately impacted by HIV. While Latinos make up 18% of the United States population, they account for 29% of new HIV diagnoses in the country.1Viviendo Valiente was created to reduce these disparities by increasing HIV testing and engagement in care among Latinos of Mexican descent.
Promotores, Latino-identifying Spanish-speaking staff, provide culturally responsive services to clients. Promotores are vital to Viviendo Valiente because they represent the local community and are at the forefront of individual-, group-, and community-level activities.
Promotores support medication adherence, and linkage to and retention in HIV care, through antiretroviral treatment and access to services (ARTAS). This strengths-based approach revolves around multiple individual sessions with clients to help them overcome barriers to HIV care. Promotores also link clients to support services, such as transportation and food assistance.
Promotores facilitate group-level activities, such as presentations, discussions, and workshops, to educate participants on HIV and related care. Sessions address HIV/STI transmission and risk reduction, testing and treatment, and engagement and retention in care.
Viviendo Valiente educates the community on testing resources, risk reduction, and HIV care through informational sessions, health fairs, social media, print media, and radio. Promotores are at the forefront of these activities to gain trust and build relationships with the respective communities.
Viviendo Valiente prioritizes the duality of the client’s place of origin and their experience residing in the U.S. to tailor how services are delivered to the priority population. This transnational approach explores social, economic, and educational factors related to migration and connectedness to two or more cultures, and their effects on health behaviors and outcomes.
The original Viviendo Valiente evaluation included 123 people who participated in the individual-level intervention; after one year, 74 percent were retained in care and 79 percent reached viral suppression. Additionally, HIV testing among Latinos overall and Latino men who have sex with men (MSM) increased for those who participated in the community-level intervention.
Source: U.S. Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau. Viviendo Valiente Intervention Implementation Guide. Rockville, Maryland: U.S. Department of Health and Human Services, 2022.
Community Partnerships. Viviendo Valiente developed and leveraged partnerships with community stakeholders to gain access to the priority population. Partnerships were formed with faith-based organizations, clinics, treatment centers, and local recreation teams. Almost half of all referrals for the individual-level activities came from these organizations. Viviendo Valiente also received support from its community advisory board and volunteers. These partnerships helped build trust and rapport with the community to mitigate structural barriers and medical mistrust.
Staffing. The Viviendo Valiente leadership team consisted of a director, responsible for developing and managing stakeholder relationships, and a lead Promotor who oversaw the program and provided guidance to all Promotores.
Training. Promotores completed training on HIV education, antiretroviral therapy, case management, and transnationalism. They also became certified as community health workers. These trainings were carried out through online courses, workshops, and presentations.
Stakeholder input. Viviendo Valiente conducted a Mexican community needs assessment and created a community advisory board to inform program design, based on the community’s perspectives and needs.
- Viviendo Valiente was funded by the SPNS Culturally Appropriate Interventions of Outreach, Access, and Retention Among Latino/a Populations initiative. The grant funded staff time and training for Promotores, client transportation and snacks, as well as a direct phone line for Spanish speakers.
- Building and maintaining strategic partnerships played a vital role in client recruitment and support services. Community organizations helped Viviendo Valiente build rapport within the community while mitigating barriers such as stigma, medical distrust, and structural issues.
- Culturally and Linguistically Appropriate Services (CLAS) Standards can provide an important framework for assessing staff on cultural responsiveness and for implementing related trainings.
- Social marketing and client recruitment must be tailored to the needs of priority populations. Visuals and interactive activities can reinforce messages, especially among populations with limited health literacy.