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

项目摘要 跨性别和性别多样性（例如，性别非二元）（TGD）个体仍然是一个隐藏的群体， 中欧和东欧国家罗马尼亚，几乎没有保护，几乎没有平等权利，许多权利得不到满足 需求对该地区TGD人的新研究表明，TGD罗马尼亚人特别报告， 艾滋病毒，抑郁症和危险酒精使用率高，主要是由于该国的高结构性 耻辱罗马尼亚的医疗保健系统在应对这些流行病的健康威胁方面缺乏专业知识。没有 迄今已有针对性的需求评估或干预措施，以纠正这些不利因素， TGD在罗马尼亚或中东欧任何地方的福祉-该地区艾滋病毒流行增长最快， 世界作为回应，我们建议在中欧和东欧建立和试点测试第一个干预措施，以解决性， 心理和行为健康状况。2014年，在罗马尼亚LGBTQ社区的投入下，我们 创建了沟通干预，成功地帮助减少了同性恋和双性恋男性的 艾滋病毒风险和危险的酒精使用，并改善他们的心理健康。干预的理论和技术 基于动机访谈和认知行为技能培训，以适应少数民族的压力。 现场咨询会话通过文本在任何移动终端上访问的安全平台上提供， 以满足参与者对机动性和隐蔽性的高度需求。在本补充文件中，我们建议 调整和试点测试通信，以解决TGD面临的共同和独特的少数民族压力决定因素 罗马尼亚人减少艾滋病毒风险，抑郁症和危险的酒精使用。我们的改编将遵循 性别少数压力框架，承认独特的TGD压力源，其影响我们的干预 打算修改。在目标1（月1-5）中，我们将确定罗马尼亚TGD个体的独特健康需求 并修改通信干预措施以解决这些问题。我们将采访20名罗马尼亚TGD个人， 报告艾滋病毒风险，抑郁症和危险的酒精使用，和10个TGD肯定的卫生提供者，以确定 TGD特定的健康需求和建议的适应性通信。在目标2（mo 6）中，我们将迭代修改 通信社干预内容是解决性别少数压力和其他与性别平等有关的具体决定因素， 艾滋病毒风险，心理健康和危险的酒精使用。最后，在目标3（mos 7-12）中，我们将评估新的 干预的可行性和可接受性在一个单臂试验与20 TGD罗马尼亚人谁报告艾滋病毒的风险， 抑郁症和危险的酒精使用。将在基线和3个月随访时收集数据。这个项目 建立在我们强大的NIH支持的研究计划，专注于LGBTQ人群在罗马尼亚的健康， 为了创建第一个干预措施，以解决TGD罗马尼亚人的性，心理和行为健康问题。 通过将我们的干预研究扩展到高危TGD人群，我们将确保更公平地获得我们的 干预措施，并将其纳入日益渴望和能够达到的国家基础设施 罗马尼亚LGBTQ人口的充分多样性，以解决其目前未满足的需求。

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.