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: 10220169
• 负责人: Xianhong LI
• 金额: $ 19.03万
• 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 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10220169
• 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; Hour; Impulsivity; Individual; Internet; Intervention; Interview; Legal; Lesbian Gay Bisexual Transgender Queer; Manuals; Measures; Medical; Mental Depression; Mental Health; Minority; Monitor; Moods; Newly Diagnosed; 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 barriers; implementation facilitators; implementation outcomes; 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.

项目概要 背景。中国同性恋、双性恋和其他男男性行为者 (MSM) 的艾滋病毒感染率 从2003年的不到1.0%上升到2016年的9.2%。如果不采取行动，中国六分之一的男男性行为者 到 2025 年感染艾滋病毒；大多数人都是年轻人（YMSM）。耻辱加剧了中国艾滋病毒在人群中的流行 YMSM。中国YMSM缺乏平等权利和法律保护，身份隐瞒属常态， 转变疗法很普遍。中国人的孝道和遵守规范的价值观进一步给 YMSM 带来压力。 这种耻辱引起了少数人的压力反应，包括身份隐藏、内在的同性否定、 以及对基于身份的拒绝的敏感性。少数群体的压力和相关的不良心理健康都会受到损害 YMSM 通过回避应对、低自我价值感、冲动和缺乏自信来预防艾滋病毒。我们的团队 创建了第一个通过 YMSM 进行功效测试的干预措施，以解决这些少数群体的压力反应 及相关流程。这种名为 ESTEEM 的认知行为 (CBT) 干预措施显示出强大的初步效果 在少数群体压力、心理健康和艾滋病毒风险行为方面的功效。然而，ESTEEM 是在美国开发的 目前需要亲自提供 10 场 1 小时的会议，妨碍了在 中国。现在，我们研究的进步使我们能够为 ESTEEM 的广泛影响做好准备。初步的 研究。首先，我们通过 8 个阶段的适应，对中国 YMSM 进行了文化上的面对面 ESTEEM 调整 与 YMSM 和利益相关者 (n=56) 合作的流程，包括与中国 YMSM (n=8) 的小型开放试点。第二， 我们与瑞典的同事——基于互联网的 CBT (iCBT) 领域的世界领导者——合作创建了 iCBT ESTEEM 版本。 iCBT 将自助式移动平台与简短的辅导员反馈和在线结合起来 练习和家庭作业，比面对面的 ESTEEM 减少 80% 的辅导时间。在美国的一个小型飞行员中 (n=10)，iCBT ESTEEM 功能强大。我们将这些进步融入到发展中国人的ESTEEM中 iCBT – 一种高效的私人干预措施，可解决艾滋病毒等少数群体压力和心理健康问题 预防。目标。 (1) 改造我们最近创建的中文 ESTEEM 面对面材料（例如手册、 讲义）融入 iCBT 内容（例如自学练习、视频）并确保其理解（n=10 YMSM）。 (2) 测试中国ESTEEM iCBT降低YMSM过去90天HIV风险的初步效果 行为，反对每周的自我监控控制。 (3) 识别实施障碍和促进因素 中国 ESTEEM iCBT 通过分析目标 2 数据（例如，辅导员忠诚度）和定性访谈 目标 2 参与者 (n=20)、顾问 (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），以及实施伙伴（例如艾滋病毒预防非政府组织、LGBTQ 中心，n=12）。在开发高度 传播我们少数群体压力心理健康干预措施的有效平台，我们也将自己定位为 持续的未来合作，包括研究这种干预措施的最终采用情况 中国和其他受艾滋病毒严重影响的低/中等收入国家的既定环境。