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

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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.