Building mobile HIV prevention and mental health support in low-resource settings

项目总结

Project Summary Transgender and gender diverse (e.g., gender non-binary) (TGD) individuals remain a hidden group in the Central Eastern European (CEE) country of Romania, with few protections, few equal rights, and many unmet needs. Emerging research with TGD persons in the region indicates that TGD Romanians report particularly high rates of HIV, depression, and hazardous alcohol use, primarily driven by the country’s high structural stigma. Romania’s healthcare system has little expertise for addressing these syndemic health threats. No targeted needs assessments or interventions exist to date in order to remedy these adversities and promote the wellbeing of TGD in Romania, or anywhere in CEE – the region with the fastest-growing HIV epidemic in the world. In response, we propose to create and pilot-test the first intervention in CEE to address the sexual, mental, and behavioral health of TGD people. In 2014, with input from the Romanian LGBTQ community, we created the Comunică [Communicate] intervention, which successfully helped reduce gay and bisexual men’s HIV risk and hazardous alcohol use and improve their mental health. The intervention’s theory and techniques are based on motivational interviewing and cognitive behavioral skills training as adapted for minority stress. Live counseling sessions are delivered by text on a secure platform accessed on any mobile device, which is responsive to participants’ high need for mobility and concealment. In this supplement, we propose to now adapt and pilot-test Comunică to address the shared and unique minority stress determinants facing TGD Romanians to reduce HIV risk, depression, and hazardous alcohol use. Our adaptation will be guided by the gender minority stress framework that acknowledges unique TGD stressors, whose impact our intervention intends to modify. In Aim 1 (mos 1-5), we will identify the unique health needs of Romanian TGD individuals and modify the Comunică intervention to address them. We will interview 20 Romanian TGD individuals who report HIV risk, depression, and hazardous alcohol use, and 10 TGD-affirmative health providers to identify TGD-specific health needs and suggested adaptations to Comunică. In Aim 2 (mo 6), we will iteratively modify the Comunică intervention content to address gender minority stress and other TGD-specific determinants of HIV risk, mental health, and hazardous alcohol use. Finally, in Aim 3 (mos 7-12), we will evaluate the new intervention’s feasibility and acceptability in a one-arm trial with 20 TGD Romanians who report HIV risk, depression, and hazardous alcohol use. Data will be collected at baseline and 3-month follow-up. This project builds on our strong NIH-supported research program focused on the health of LGBTQ people in Romania, in order to create the first intervention to address the sexual, mental, and behavioral health of TGD Romanians. By extending our intervention research to at-risk TGD populations, we will ensure more equitable access to our interventions and embed them within a national infrastructure increasingly eager for and capable of reaching the full diversity of the Romanian LGBTQ population to address its currently unmet needs.