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

项目摘要 针对同性恋和双性恋男性（GBM）的污名化被认为会造成少数民族压力的状况 以一种流行病的方式影响他们的精神和性健康，导致焦虑，抑郁，自杀， 药物和酒精滥用以及危险的性行为。恢复力被认为是一种重要的保护 少数民族的压力。最近美国-研究表明，ESTEEM，一种认知行为， 以治疗为基础的干预，旨在促进个人的机构和弹性是有效的改善 年轻GBM的心理和性健康。然而，迫切需要调整现有的少数民族压力， 干预措施的可扩展性，以适应生活在恶劣环境中的GBM个人的当地情况， 资源（特别是在非西方国家）。尽管在越南，男子之间的自愿性行为是法律的， GBM在日常生活中面临着许多挑战。与此同时，关于这方面的定量数据很少。 GBM的心理健康状况，包括耻辱和其他因素在导致心理和性健康方面的作用 这个人群的问题。在这方面，我们建议制定和试行一个以社区为基础的， 同龄人驱动的少数民族的压力以及艾滋病毒的耻辱减少计划的基础上ESTEEM在小 越南胡志明市（胡志明市）自称GBM的团体。干预（"Vina-STEAM"-- 赋予持肯定态度的男子权力的技能）旨在建立对少数群体压力和艾滋病毒相关问题的复原力。 以促进积极的性健康。具体来说，我们假设干预 将导致更定期的艾滋病毒检测和参与PrEP预防工作， 在消极行为（即，酗酒;非法药物使用;无保护的肛交）和心理 (i.e.,焦虑和抑郁）压力源。我们的混合方法研究将包括：（1）准备阶段，（2） 形成阶段，来自越南GBM和关键线人的定性数据将为适应提供信息， ESTEEM方案;（3）可行性测试，在小样本中对经调整的干预措施进行试点测试 （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 在120例GBM队列中使用随机等待列表对照设计对调整后的干预措施进行检验，其中 他们将被随机分配到立即干预组或候补名单控制组，每组10人 (i.e. 12组）。拟议的干预措施将是促进少数群体复原力的首批措施之一。 发展中国家GBM的压力（即，越南），那里有说服力的同性恋恐惧症 耻辱此外，它是第一个测试同行领导的干预解决少数群体的影响 强调在这种环境下GBM心理和性健康。如果成功的话，这种干预可以 扩展用于完整的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。

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.