Developing efficient intervention technologies to reduce stigma-related stress, mental health problems, and HIV risk among young Chinese MSM

开发有效的干预技术，以减少中国年轻男男性行为者中与耻辱相关的压力、心理健康问题和艾滋病毒风险

• 批准号: 10055475
• 负责人: Xianhong LI
• 金额: $ 24.68万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-08-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10055475
• 关键词: AIDS prevention; Address; Adherence; Affect; Age; Anal Sex; Anxiety; Asia; Back; Behavior; Behavioral; Bisexual; Caring; Centers for Disease Control and Prevention (U.S.); China; Chinese People; Clinic; Cognitive; Cognitive Therapy; Collaborations; Comprehension; Country; Data; Depressed mood; Discrimination; Ensure; Epidemic; Evidence based intervention; Evidence based treatment; Exercise; Face; Family; Feedback; Future; Gays; Government; HIV; HIV Infections; HIV Seronegativity; HIV risk; HIV/STD; Health Services; Heterosexuals; Home environment; Hour; Impulsivity; Individual; Internet; Intervention; Interview; Legal; Lesbian Gay Bisexual Transgender Queer; Manuals; Measures; Medical; Mental Depression; Mental Health; Minority; Monitor; Moods; Newly Diagnosed; Outcome; Participant; Persons; Positioning Attribute; Prevalence; Privatization; Process; Professional counselor; Provider; Randomized; Research; Resources; Rights; Risk; Risk Behaviors; Same-sex; Sex Education; Sex Orientation; Sexual Health; Stress; Structure; Sweden; Technology; Testing; Time; TimeLine; Treatment Efficacy; Work; anxious; base; biological adaptation to stress; coping; effective intervention; efficacy testing; health disparity; implementation science; low and middle-income countries; men; men who have sex with men; mobile computing; pre-exposure prophylaxis; prevent; primary outcome; programs; psychologic; same-sex marriage; secondary outcome; skills; social stigma; stem; stressor; transmission process; trend; uptake; web platform; young men who have sex with men

PROJECT SUMMARY Background. HIV prevalence among gay, bisexual, and other men who have sex with men (MSM) in China has increased from less than 1.0% in 2003 to 9.2% in 2016. Lack of action will lead to 1 in 6 Chinese MSM being infected with HIV by 2025; the majority will be young (YMSM). Stigma fuels China’s HIV epidemic among YMSM. Chinese YMSM face a lack of equal rights and legal protections, identity concealment is normative, and conversion therapy is widespread. Chinese values of filial piety and norm conformity further strain YMSM. This stigma gives rise to minority stress reactions, including identity concealment, internalized homonegativity, and sensitivity to identity-based rejection. Both minority stress and associated poor mental health compromise YMSM’s HIV prevention through avoidance coping, low self-worth, impulsivity, and unassertiveness. Our team has created the first intervention tested for efficacy with YMSM that addresses these minority stress reactions and related processes. This cognitive-behavioral (CBT) intervention, called ESTEEM, shows strong preliminary efficacy across minority stress, mental health, and HIV risk behavior. Yet, ESTEEM was developed in the US and currently requires in-person delivery of 10 1-hour sessions, precluding widespread implementation in China. Now, advancements in our research allow us to prepare ESTEEM for broad reach. Preliminary Studies. First, we culturally adapted in-person ESTEEM for Chinese YMSM across an 8-stage adaptation process with YMSM and stakeholders (n=56), including a small open pilot with Chinese YMSM (n=8). Second, we worked with our colleagues in Sweden – world leaders in internet-based CBT (iCBT) – to create an iCBT version of ESTEEM. iCBT combines a self-guided mobile platform with brief counselor feedback and online exercises and homework, requiring 80% less counselor time than in-person ESTEEM. In a small US pilot (n=10), iCBT ESTEEM was highly functional. We incorporate these advances to develop Chinese ESTEEM iCBT – a highly efficient, private intervention that addresses minority stress and mental health as HIV prevention. Aims. (1) Transform our recently created Chinese ESTEEM in-person materials (e.g., manual, handouts) into iCBT content (e.g., self-guided exercises, videos) and ensure its comprehension (n=10 YMSM). (2) Test the initial efficacy of Chinese ESTEEM iCBT for reducing at-risk YMSM’s past-90-day HIV-risk behavior, against a weekly self-monitoring control. (3) Identify implementation barriers and facilitators of Chinese ESTEEM iCBT through analysis of Aim 2 data (e.g., counselor fidelity) and qualitative interviews with Aim 2 participants (n=20), counselors (n=4), government stakeholders (e.g., Chinese CDC, medical clinic staff, n=12), and implementing partners (e.g., HIV-prevention NGOs, LGBTQ centers, n=12). In developing a highly efficient platform to disseminate our minority stress-mental health intervention, we also position ourselves for sustained future collaboration, including on research to study the ultimate uptake of this intervention in established settings across China and other low/middle-income countries severely affected by HIV.

项目摘要 背景。同性恋，双性恋和其他与男人发生性关系（MSM）的艾滋病毒流行 从2003年的不到1.0％增加到2016年的9.2％。缺乏行动将导致6个中国MSM中的1个 到2025年被艾滋病毒感染；大多数将是年轻的（YMSM）。污名化中国的艾滋病毒流行 YMSM。中国YMSM面临缺乏平等权利和法律保护，身份隐瞒是正常的， 转化疗法是广泛的。中国的纯粹虔诚和规范合格的价值进一步应变YMSM。 这种污名引起了少数族裔压力反应，包括身份隐藏，内在的同性恋， 对基于身份的拒绝的敏感性。少数群体压力和相关的心理健康不良妥协 YMSM通过避免应对，低自我价值，冲动和统一的预防艾滋病毒预防。我们的团队 已经创建了第一次用YMSM测试的干预措施，该干预措施解决了这些少数压力反应 和相关过程。这种认知行为（CBT）的干预措施称为尊重，显示出强烈的初步 少数群体压力，心理健康和艾滋病毒风险行为的疗效。然而，在美国发展了尊敬 目前需要面对面交付10个1小时的会议，排除了宽度的实施 中国。现在，我们的研究进步使我们能够为广泛的范围做好尊敬。初步的 研究。首先，我们在文化上对中国YMSM进行了8阶段改编的亲自尊敬 YMSM和利益相关者的过程（n = 56），包括一个带有中国YMSM的小型飞行员（n = 8）。第二， 我们与瑞典的同事 - 基于Internet的CBT（ICBT）的世界领导人 - 创建ICBT 尊敬的版本。 ICBT将一个自引导的移动平台与简短的辅导员反馈和在线结合在一起 练习和作业，辅导员时间比面对面的尊敬要少80％。在一个小型飞行员中 （n = 10），ICBT尊敬高度功能。我们结合了这些进步以发展中国的自尊心 ICBT - 一种高效，私人干预措施，以艾滋病毒为少数群体压力和心理健康 预防。目标。 （1）改变我们最近创造的中国尊敬面对面材料（例如，手册， 讲义）插入ICBT内容（例如，自导练习，视频）并确保其理解（n = 10 ymsm）。 （2）测试中国尊敬ICBT的初始效率，以降低高危YMSM的过去90天HIV风险 行为，反对每周的自我监控控制。 （3）确定实施障碍和促进者 中国尊敬ICBT通过分析目标2数据（例如，辅导员保真度）和定性访谈 AIM 2参与者（n = 20），ComunSeleors（n = 4），政府利益相关者（例如中国疾病预防控制中心，医疗诊所工作人员， n = 12），并实施伙伴（例如，HIV预防非政府组织，LGBTQ中心，n = 12）。在发展高度 有效的平台传播我们的少数派压力性健康干预措施，我们也为自己定位 持续的未来合作，包括研究研究这种干预措施的最终吸收 在中国和其他低/中等收入国家中建立的环境严重影响了艾滋病毒。