Increasing engagement and improving HIV care outcomes via stigma reduction in an online social networking intervention among racially diverse young men who have sex with men and transgender women

摘要 与性、种族和艾滋病毒感染有关的多重耻辱对艾滋病毒检测、参与艾滋病毒 护理，并在与男性发生性关系的年轻黑人或拉丁美洲男子中持续抑制病毒（VS）， 跨性别妇女（YBLMT）。目前，很少有干预措施解决交叉污名的影响 在艾滋病毒感染者和未感染者中。作为对RFA-MH-18-606的响应，本研究测试了 针对交叉污名改善的在线干预可以获得在线社会支持，促进 干预参与，并减轻艾滋病毒相关结果的多重耻辱的影响。我们将招募 招募1,050名年轻（15-29岁）、种族和民族多样化的男性， 受艾滋病毒感染的跨性别女性。使用HIV状态分层随机试验 设计，参与者将被分配到三个条件之一（仅信息控制，研究人员驱动， 社交网络干预或同伴驱动的社交网络干预）。行为评估将在 基线、3、6、9和12个月;生物标志物（病毒载量）计划用于基线、6和12个月。的 主要结局按HIV状态分层，并定义为成功参与护理（一致VS HIV阳性参与者和HIV阴性参与者的常规检测）。具体目标是：1）测试 促进用户生成内容和参与的在线干预是否可以解决 交叉羞辱与艾滋病毒预防和护理连续体的改善有关（艾滋病毒检测， 抗逆转录病毒依从性，VS）与仅提供信息的对照组相比; 2）探索用户是否 通过定量和定性的参与来衡量，参与调解了干预措施的污名化， 艾滋病毒护理相关的结果;以及，3）检查交叉羞辱的变化和跨部门的改善 艾滋病毒护理连续体在研究人员驱动的社会网络干预与同伴驱动的社会网络干预之间存在差异 条件我们的研究是创新的，因为它的重点是交叉污名作为一个关键目标， 干预，以及评估不同类型的在线社交网络结构如何影响 参与者的参与随着时间的推移，减少交叉污名的经验，并提高成功的 参与护理。这项研究解决了一个迫切需要减少多重污名的影响， 通过一项极具吸引力、广泛使用的技术，利用干预措施，为重点人群提供服务。如果 有效的，这种形式的耻辱改善通过在线支持可以广泛传播，以减少艾滋病毒 传播和改善YBLMT之间的护理。

ABSTRACT Multiple stigmas related to sexuality, race, and HIV infection negatively impact HIV testing, engagement in HIV care, and consistent viral suppression (VS) among young Black or Latino men who have sex with men and transgender women (YBLMT). At present, few interventions have addressed the effects of intersectional stigma among HIV-infected and uninfected populations. In response to RFA-MH-18-606, this study tests whether an online intervention tailored for intersectional stigma amelioration can elicit online social support, promote intervention engagement, and mitigate the impact of multiple stigmas on HIV-related outcomes. We will recruit and enroll 1,050 young (ages 15-29), racially and ethnically diverse men who have sex with men and transgender women affected by HIV across the United States. Using a HIV-status stratified randomized trial design, participants will be assigned into one of three conditions (information-only control, a researcher-driven social network intervention, or a peer-driven social network intervention). Behavioral assessments will occur at baseline, 3, 6, 9 and 12 months; biomarkers (viral load) are scheduled for baseline, 6 and 12 months. The primary outcome is stratified by HIV status and defined as successful engagement in care (consistent VS for HIV-positive participants and routine testing for HIV-negative participants). The specific aims are: 1) Test whether an online intervention that promotes user-generated content and engagement to address intersectional stigma is associated with improvements in the HIV prevention and care continuum (HIV testing, antiretroviral adherence, VS) as compared to an information-only control arm; 2) Explore whether user engagement, as measured by quantitative and qualitative paradata, mediates the intervention’s stigma- and HIV care-related outcomes; and, 3) Examine how changes in intersectional stigma and improvements across the HIV care continuum vary between the researcher-driven vs. peer-driven social network intervention conditions. Our research study is innovative given its focus on intersectional stigma as a key target of intervention, and its ability to assess how different kinds of online social network structures influence participants’ engagement over time, reduce experiences of intersectional stigma, and improve successful engagement in care. This research addresses a critical need to reduce the effects of multiple stigmas in a priority population using an intervention delivered through a highly appealing, widely-utilized technology. If effective, this form of stigma amelioration via online support can be broadly disseminated to reduce HIV transmission and improve care among YBLMT.