Reducing the intersecting stigmas of HIV, violence victimization, and mental health: a randomized controlled pilot integrating Project YES! Youth Engaging for Success and Problem Management Plus amon

项目摘要/摘要 耻辱日益被认为是影响抗逆转录病毒治疗依从性和病毒感染的可改变因素 对青少年和青年艾滋病毒携带者的抑制(AYALHIV)，但很少有干预措施 有效地减少了耻辱或解决了这一群体中的交叉耻辱。在这项研究中，我们将解决 AYALHIV中内在化的艾滋病毒污名，以及与流行的青年有关的内在化污名 暴力和抑郁的经历。此外，我们还将重点关注跨部门污名，捕捉 预计与AYALHIV多重社会身份的复杂现实有关的耻辱。我们将创建一个 通过循证干预项目来减少这些多重污名的干预是的！ 为成功而奋斗的青年。项目是的！是一种同伴指导计划，有效地减少了艾滋病毒的内在化 赞比亚15至24岁AYALHIV患者和部分儿科诊所参与者的耻辱， 加强了对病毒的抑制。项目是的！数据还强调了关键的干预差距，包括高 AYALHIV中身体、性和/或情感暴力受害的程度，以及参与者如何 筛查出抑郁症阳性的患者病毒抑制水平较低。这一数据与越来越多的 将暴力、受害和抑郁与内在化的耻辱和病毒失败联系起来的证据。项目是的！ 同伴导师会将有暴力经历或抑郁和焦虑的参与者转介到诊所健康中心 在为AYALHIV提供最低限度的精神健康培训或服务的系统中的工作人员。这项研究旨在 通过整合减少污名EBI青少年同伴指导计划(项目是！)来解决这一差距。与 世界卫生组织认可并证明了减少抑郁症状的心理健康方法 和焦虑(问题管理(PM)和青少年早期情绪技能(EASE)) 由非专业卫生工作者提供。通过调整和集成PM/EASE来创建Project YES，我们将 特别是为AYALHIV提供问题管理技能，我们假设这些技能将中断双向 暴力受害、抑郁和内在化和交叉性污名之间的路径。我们还将 完善我们对与暴力和抑郁有关的内在化耻辱以及跨部门耻辱的衡量标准。 具体研究目标包括： 目标1：调整和整合世卫组织以问题管理为基础的项目管理/缓解办法(15-24 几年)创建由业外青年导师实施的是项目，以通过减少 与艾滋病毒、暴力和抑郁症有关的内在化和跨部门污名。 目标2：使用认知访谈调整暴力和抑郁相关的内在化污名和 改进AYAHLIHV间柱头测量的交叉柱头。 目标3：评估项目是跨部门减少污名干预的可行性和可接受性 在100名AYALHIV中通过先导性随机对照试验。

PROJECT SUMMARY / ABSTRACT Stigma is increasingly recognized as a modifiable factor impacting antiretroviral therapy adherence and viral suppression among adolescents and young adults living with HIV (AYALHIV), however few interventions have effectively reduced stigma or address intersectional stigma among this population. In this study we will address internalized HIV stigma among AYALHIV, as well as internalized stigmas related to the prevalent youth experiences of violence and depression. Further, we will also focus on intersectional stigma, capturing anticipated stigma associated with the complex reality of AYALHIV’s multiple social identities. We will create an intervention to reduce these multiple stigmas by building upon the evidence-based intervention Project YES! Youth Engaging for Success. Project YES! is a peer mentoring program that effectively reduced HIV-internalized stigma among 15-to 24-year old AYALHIV in Zambia, and among a subset of pediatric clinic participants, increased their viral suppression. Project YES! data also highlighted critical intervention gaps, including high levels of physical, sexual and/or emotional violence victimization among AYALHIV, and how participants who screened positive for depression had lower levels of viral suppression. This data aligns with a growing body of evidence linking violence victimization and depression with internalized stigma and viral failure. Project YES! peer mentors would refer participants with violence experiences or depression and anxiety to the clinic health staff in a system that provides minimal mental health training or services for AYALHIV. This research seeks to address this gap by integrating the stigma reducing EBI youth peer mentoring program (Project YES!) with the World Health Organization endorsed and proven mental health approaches that reduce symptoms of depression and anxiety (Problem Management Plus (PM+) and Early Adolescent Skills for Emotions (EASE)) that are delivered by lay health workers. By adapting and integrating PM+/EASE to create Project YES+, we will specifically provide AYALHIV with problem-management skills that we hypothesize will interrupt the bi-directional pathways among violence victimization, depression and internalized and intersectional stigmas. We will also refine our measures of internalized stigmas related to violence and depression, and intersectional stigma. Specific study aims include: AIM 1: Adapt and integrate the WHO problem management-based PM+/EASE approaches for AYA (15-24 years) to create Project YES+ for implementation by lay youth mentors to improve viral status by reducing the internalized and intersectional stigmas related to HIV, violence, and depression. Aim 2: Use cognitive interviewing to adapt scales of violence- and depression-related internalized stigma and intersectional stigma to improve stigma measurement among AYAHLIHV. Aim 3: Assess the feasibility and acceptability of a Project YES+ intersectional stigma reduction intervention among 100 AYALHIV through a pilot randomized controlled trial.