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

项目总结 针对男同性恋者和双性恋者(GBM)的污名会造成少数民族压力的状况 以一种共同的方式影响他们的心理和性健康，导致焦虑、抑郁、自杀、 滥用药物和酒精以及危险的性行为。复原力被认为是一种重要的保护 对抗少数族裔压力的因素。最近美国的一项研究表明，自尊是一种认知行为 旨在促进个人代理和韧性的基于治疗的干预在提高个人能力和韧性方面有效 青壮年儿童的心理和性健康状况。然而，迫切需要适应现有的少数群体压力。 对生活在有限恶劣环境中的GBM个人的当地环境可伸缩性的干预措施 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。与此同时，几乎没有关于经济增长的量化数据。 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 这些人口中存在的问题。在这方面，我们建议开发和试点以社区为基础的 同龄人驱动的少数民族压力以及基于小规模尊重的艾滋病毒污名减少方案 越南胡志明市(胡志明市)自称为GBM的团体。干预(“Vina-STEAM”-- 赋予男性权力的技能)旨在培养对少数族裔压力和艾滋病毒相关疾病的适应能力 耻辱，以促进积极的性健康。具体地说，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，因为减少了 在消极行为(即酗酒；非法吸毒；无保护的肛交)和心理方面 (即焦虑和抑郁)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和主要信息者的质量数据将为适应提供信息 自尊一揽子计划；(3)可行性测试，其中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)，并根据中试结果进一步调整；(4)小规模疗效 在120 GBM的队列中使用随机等待名单对照设计对调整后的干预进行测试，其中 他们将被随机分配到立即干预或等待名单控制的ARM中，每组10人 (即12组)。拟议中的干预措施将是首批促进少数族裔适应能力的干预措施之一 在发展中国家(即越南)的GBM中存在压力，在那里有说服力的同性恋恐惧症 耻辱。此外，它也是首批测试同行主导的干预措施以解决少数族裔影响的机构之一 在这样的环境下，对GBM的心理和性健康的压力。如果成功，这种干预可以 扩大用于全面的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.