Building Resilience to Minority Stress and HIV-related Stigma for Promoting Positive Sexual Health among Vietnamese High-risk Men

增强对少数群体压力和艾滋病毒相关耻辱的抵御能力，以促进越南高危男性积极的性健康

• 批准号: 10299836
• 负责人: Donn Colby
• 金额: $ 17.43万
• 依托单位: FLORIDA STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-08-16 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10299836
• 关键词: AIDS/HIV problem; Address; Affect; Alcohol abuse; Alcohols; Anxiety; Attention; Behavioral; Bisexual; Cities; Clinical; Cognitive Therapy; Communities; Country; Coupled; Data; Depression and Suicide; Developing Countries; Environment; Face; Feeling suicidal; Foundations; Gays; Goals; HIV; HIV Seronegativity; Health; Health Status; Homophobia; Human immunodeficiency virus test; Individual; Intervention; Legal; Literature; Mental Depression; Mental Health; Methods; Minority; New York; Outcome; Pharmaceutical Preparations; Population; Preparation; Prevention; Process; Psychologist; Public Health; Randomized; Research; Resources; Risk; Role; Sampling; Sex Orientation; Sexual Health; Sexually Transmitted Diseases; Stigmatization; Stress; Substance abuse problem; Suicide attempt; Test Result; Testing; United States; Vietnam; Waiting Lists; alcohol misuse; arm; base; cohort; condomless anal sex; design; efficacy testing; efficacy trial; feasibility testing; high risk men; illicit drug use; improved; informant; innovation; intervention program; low and middle-income countries; men; peer; peer support; pre-exposure prophylaxis; programs; protective factors; psychologic; psychosocial; resilience; response; rural area; sex; skills; social; social stigma; stressor

PROJECT SUMMARY Stigma directed towards gay and bisexual men (GBM) are known to create the condition of minority stress that affects their mental and sexual health in a syndemic manner, resulting in anxiety, depression, suicide, substance and alcohol abuse and risky sexual practices. Resilience is recognized as an important protective factor against minority stress. A recent U.S.-based study demonstrated that ESTEEM, a cognitive behavioral therapy-based intervention aimed at promoting personal agency and resilience is efficacious in improving mental and sexual health of young GBM. However, there is an urgent need to adapt existing minority stress interventions for scalability to the local context of GBM individuals living in hostile environment with limited resources (especially in non-Western countries). Despite consensual sex between men is legal in Viet Nam, GBM face many challenges in their daily lives. Meanwhile, little quantitative data are available regarding the mental health status of GBM, including the role of stigma and other factors in causing mental and sexual health problems in this population. In this regard, we propose to develop and pilot test a community-based, peer-driven minority stress as well as HIV-stigma reduction program based on ESTEEM in small groups of self-identified GBM in Ho Chi Minh City (HCMC), Viet Nam. The intervention (“Vina-STEAM”-- Skills to Empower Affirmative Men) is aimed to build resilience to minority stress and HIV-related stigma in order to promote positive sexual health. Specifically, we hypothesize that the intervention will result in more regular HIV testing and engagement of PrEP prevention efforts due to the reduction in negative behavioral (i.e., alcohol abuse; illicit drug use; unprotected anal sex) and psychological (i.e., anxiety and depression) stressors. Our mixed-method study will involve: (1) preparation stage, (2) formative stage, where qualitative data from Vietnamese GBM and key informants will inform adaptation of the ESTEEM package; (3) feasibility test, where the adapted intervention will be pilot-tested in a small sample (4 small groups, N = 24) of GBM and further adjusted based on the pilot-test results; (4) small-scale efficacy test of the adjusted intervention using a randomized wait-list controlled design in a cohort of 120 GBM, where they will be randomly assigned to either an immediate intervention or a waitlist controlled arm in groups of 10 (i.e. 12 groups). The proposed intervention will be one of the first to promote resilience to minority stress among GBM in a developing country (i.e., Viet Nam), where there is persuasive homophobic stigma. Also, it is one of the first to test a peer-led intervention addressing the impact of minority stress on mental and sexual health of GBM in such setting. If successful, this intervention can be expanded for a full R01 efficacy trial and adapted for use in other highly marginalized GBM populations, e.g. those residing in rural areas of the United States as well as GBM in other developing countries.

项目概要 众所周知，针对男同性恋和双性恋男性 (GBM) 的耻辱会造成少数群体压力 以综合症的方式影响他们的心理和性健康，导致焦虑、抑郁、自杀、 药物和酒精滥用以及危险的性行为被认为是一种重要的保护措施。 美国最近的一项研究表明，ESTEEM 是一种认知行为。 旨在促进个人能动性和复原力的基于治疗的干预措施可有效改善 年轻 GBM 的心理和性健康 然而，迫切需要适应现有的少数民族压力。 对生活在敌对环境中的 GBM 个体的当地环境进行干预，其规模有限 资源（特别是在非西方国家）尽管男性之间自愿的性行为在越南是合法的， GBM 在日常生活中面临着许多挑战，同时，关于 GBM 的定量数据却很少。 GBM的心理健康状况，包括耻辱感和其他因素在导致心理和性健康中的作用 在这方面，我们建议开发并试点一个以社区为基础的、 同伴驱动的少数群体压力以及基于 ESTEEM 的小规模艾滋病毒耻辱减少计划 越南胡志明市 (HCMC) 的自我认同的 GBM 群体 干预措施（“Vina-STEAM”—— 赋予平权男性的技能）旨在增强对少数群体压力和艾滋病毒相关压力的抵御能力 耻辱，以促进积极的性健康。 由于减少，将导致更定期的艾滋病毒检测和参与 PrEP 预防工作 负面行为（即酗酒、非法药物使用、无保护的肛交）和心理 （即焦虑和抑郁）压力源。我们的混合方法研究将涉及：（1）准备阶段，（2） 形成阶段，来自越南 GBM 和关键信息提供者的定性数据将为适应 ESTEEM 包；(3) 可行性测试，调整后的干预措施将在小样本中进行试点测试 （4个小组，N = 24）GBM并根据中试结果进一步调整（4）小规模疗效； 使用随机等待名单控制设计在 120 GBM 队列中测试调整后的干预措施，其中 他们将被随机分配到立即干预组或等候名单控制组，每组 10 人 （即 12 个群体）。拟议的干预措施将是促进少数群体复原力的首批干预措施之一。 在发展中国家（即越南），GBM 面临压力，那里存在令人信服的恐同现象 此外，它是第一个测试同行主导的干预措施以解决少数群体影响的国家之一。 如果成功，这种干预措施可以对 GBM 的心理和性健康造成压力。 扩展到完整的 R01 疗效试验，并适用于其他高度边缘化的 GBM 人群，例如 居住在美国农村地区的人以及其他发展中国家的 GBM。