AIDS and Behavior

, Volume 23, Issue 4, pp 835–846 | Cite as

High HIV/STI Test Acceptance Through a Behavioral Health Encounter in Latino Immigrants with Substance Use and Mental Health Problems

  • Julie H. LevisonEmail author
  • Margarita Alegría
  • Ye Wang
  • Sheri L. Markle
  • Larmiar Fuentes
  • Dianna L. Mejia
  • Andrew Tarbox
  • Lucía Albarracín García
  • Lucía Cellerino
  • Nabila El-Bassel
Original Paper


Latino immigrants with substance use and mental health problems are at risk for undiagnosed HIV and sexually transmitted infections (STIs). Participants in a randomized control trial were recruited in Boston, USA and Madrid and Barcelona, Spain. Eligibility criteria were Latino self-identification, age 18–70, elevated substance use and mental health symptoms, and not currently in substance or mental health care. A multinomial logistic regression examined predictors of HIV/STI testing decline and lost to follow-up (LTFU) prior to testing compared with acceptance. Of 341 participants, 74% accepted testing, 4% declined, and 22% were LTFU. The odds of LTFU were higher in those with high concern for HIV and those whose main partner had done HIV testing. Age ≥ 35 years, females, higher education, and higher report of discrimination lowered the odds of LTFU. Delivery of HIV/STI testing through community agencies and outreach could overcome barriers to HIV/STI diagnosis in this population of Latinos.

Clinical Trial Number: NCT02038855


HIV Sexually transmitted infections Testing Latinos Mental health Substance use 


Los inmigrantes de origen latino con problemas de uso de sustancias y salud mental presentan un mayor riesgo de no ser diagnosticados del VIH y de las infecciones de transmisión sexual (ITS). Los participantes de este ensayo aleatorio controlado fueron reclutados en Boston, Estados Unidos y en Madrid y Barcelona, España. Los criterios de  elegibilidad incluían autoidentificarse como  Latino, tener  edad entre 18 y 70 años, síntomas  elevados de uso de sustancias y un trastorno psicológico, y no estar recibiendo ningún tratamiento para estas condiciones. Una regresión logística multinomial examinó los predictores de la  disminución del test del/las VIH/ITS y pérdida de seguimiento (PDS) antes de ofrecer el test del/las VIH/ITS comparándolo con los que aceptaron realizar el test y mantenerse en tratamiento. De los  341 participantes, un 74% aceptó realizarse las pruebas, un  4% las rechazó, y un 22% fue PDS. La probabilidad de PDS fue mayor en aquellos con alta preocupación por el VIH y en aquellos cuya pareja principal se había realizado el test del VIH. Tener más de ≥ 35 años, ser  mujer, alcanzar la educación superior, e indicar un alto nivel de discriminación percibida fueron factores relacionados con la reducción de la probabilidad de PDS. La realización del test del/las VIH/ITS a través de las agencias comunitarias y sus actividades de captación podrían superar las barreras del diagnóstico de VIH/ITS en esta población de Latinos.



The work was supported by the National Institutes Health (National Institute of Mental Health grant K23 MH100978 and National Institute on Drug Abuse grant and supplement R01 DA034952), and a CFAR ADELANTE award funded by the NIH-funded Centers for AIDS Research (P30AI050409 and P30AI117970) and the U.S. National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard University, Harvard Medical School and its affiliated academic health care centers, or the National Institutes of Health.

Authors Contributions

All authors have contributed significantly to the work, have seen and approved of this manuscript. Author contributions include formulation of the research question (Levison, Alegría, El-Bassel), design of the analytic plan (Levison, Alegría, Markle, Wang), data collection (Fuentes, Albarracín, Cellerino, Markle, Alegría), data analysis (Wang, Levison, Alegría), manuscript preparation (Levison, Alegría, Markle), and critical editing (Levison, Alegría, Wang, Markle, Mejia, Tarbox, El-Bassel). The contents of this article have not been published, and the paper is not under review elsewhere for publication.

Compliance with Ethical Standards

Conflict of interest

All authors have declared that no competing interests exist.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Julie H. Levison
    • 1
    • 2
    Email author
  • Margarita Alegría
    • 1
    • 6
    • 7
  • Ye Wang
    • 7
  • Sheri L. Markle
    • 7
  • Larmiar Fuentes
    • 7
  • Dianna L. Mejia
    • 2
  • Andrew Tarbox
    • 2
  • Lucía Albarracín García
    • 3
  • Lucía Cellerino
    • 4
  • Nabila El-Bassel
    • 5
  1. 1.Department of MedicineMassachusetts General Hospital of Harvard Medical SchoolBostonUSA
  2. 2.Division of General Internal MedicineMassachusetts General HospitalBostonUSA
  3. 3.Department of Psychiatry, Hospital Universitario Fundación Jiménez DiazMadridSpain
  4. 4.Department of Psychiatry, Vall d’Hebron University HospitalBarcelonaSpain
  5. 5.Columbia School of Social WorkNew YorkUSA
  6. 6.Department of PsychiatryMassachusetts General Hospital of Harvard Medical SchoolBostonUSA
  7. 7.Disparities Research Unit, Department of MedicineMassachusetts General HospitalBostonUSA

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