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.

项目总结 背景资料。中国男同性恋者、双性恋者及其他男男性行为者艾滋病病毒感染情况调查 从2003年的不到1.0%上升到2016年的9.2%。缺乏行动将导致六分之一的中国男男性接触者 到2025年感染艾滋病毒；大多数将是年轻人(基督教青年会)。耻辱加剧了中国在 基督教青年会。中国男男性接触者缺乏平等权利和法律保护，隐瞒身份规范， 而转换疗法也很普遍。中国人的孝道价值观和规范一致性进一步加剧了YMSM的压力。 这种耻辱会引起少数群体的压力反应，包括身份隐藏、内在化的同负性、 以及对基于身份的拒绝的敏感性。少数民族压力和相关的不良心理健康妥协 基督教青年会通过回避应对、低自我价值、冲动和不自信来预防艾滋病毒。我们队 创造了第一个用YMSM进行有效性测试的干预措施，以解决这些少数族裔的应激反应 以及相关流程。这种被称为自尊的认知-行为(CBT)干预显示出很强的初步效果 对少数民族压力、心理健康和艾滋病毒危险行为的有效性。然而，自尊是在美国发展起来的 目前需要面对面提供10个1小时的会议，因此无法在 中国。现在，我们研究的进步使我们能够为更广泛的研究做好准备。初步 研究。首先，通过8个阶段的适应，我们在文化上调整了对中国基督教青年会的面对面尊重 与基督教青年会和利益攸关方合作(n=56)，包括与中国基督教青年会的一个小型开放试点(n=8)。第二, 我们与我们在瑞典的同事-基于互联网的CBT(ICBT)的世界领先者-合作创建了iCBT 自尊的版本。ICBT将自我指导的移动平台与简短的顾问反馈和在线相结合 练习和家庭作业，与面对面的尊重相比，需要的顾问时间减少了80%。在一名小型美国飞行员中 (n=10)，iCBT自尊具有很高的功能。我们结合这些进步来培养中国人的自尊 ICBT-一种高效的私人干预措施，像艾滋病毒一样解决少数族裔压力和心理健康问题 预防。目标。(1)转换我们最近创建的中文面对面材料(例如，手册， 讲义)转化为iCBT内容(如自我指导练习、视频)，并确保其理解(n=10名基督教青年会)。 (2)检验中国自尊iCBT对降低高危男男性接触者过去90天HIV感染风险的初步效果 行为，反对每周自我监控对照。(3)确定实施障碍和促进者 中国人对iCBT的尊重通过分析Aim 2数据(例如，顾问忠诚度)和对 目的2参与者(n=20)，辅导员(n=4)，政府利益相关者(例如，中国疾控中心，医疗诊所工作人员， (n=12)和执行伙伴(例如，艾滋病毒预防非政府组织、LGBTQ中心，n=12)。在开发一种高度 传播我们少数民族压力的有效平台-心理健康干预，我们也为 持续的未来合作，包括研究这种干预的最终吸收情况 中国和其他受艾滋病毒严重影响的低收入/中等收入国家的既定环境。