Pilot Intervention for Discrimination and Mistrust Among HIV Positive Black Men

描述(由申请人提供)：所有种族/族裔和风险群体中，男男性行为者(MSM)的艾滋病毒负担最大，约占所有种族/民族MSM确诊病例的40%，占所有男性的三分之一。与其他种族/族裔相比，感染艾滋病毒的黑人不太可能被诊断、接受护理以及接受和坚持抗逆转录病毒治疗(抗逆转录病毒治疗)。黑人男男性接触者尤其表现出很低的艺术依从性。在这项为期三年的干预发展研究中，我们建议开发和试点一种与文化相关的干预措施，以减少医疗不信任和解决歧视问题。 在感染艾滋病毒的黑人男男性接触者中。我们与黑人MSM的合作表明，与文化相关的因素，如感知到的歧视和与艾滋病毒相关的医疗不信任(例如，艾滋病毒“阴谋论”，如“艾滋病毒是一种人造病毒”)导致艾滋病毒治疗行为的差异，在某些情况下，甚至比已知的高度影响因素，如抑郁和药物使用。携带艾滋病毒的黑人男男性接触者处于3个污名化的社会类别(艾滋病毒-血清状态、种族、性取向)的联结中，他们面临歧视，这反过来又可能通过增加与不良自我控制(不良适应应对、不良健康行为)有关的有害压力反应而导致差异。歧视还助长了对公共卫生实体的不信任和对医疗的怀疑。然而，还没有制定任何干预措施来克服这些与文化相关的障碍。在拟议的创新社区参与式研究项目中，我们将与一个为黑人MSM服务的艾滋病服务组织(ASO)合作，在吸引黑人MSM参与研究方面取得很大成功。在第一阶段，我们将与30名黑人男男性接触者和20名社会服务和精神健康提供者进行定性访谈，并让利益相关者参与社区咨询过程，以获得对可持续干预组成部分的意见，以提高服务提供的有效性。在第二阶段，我们将通过社区艾滋病毒支持小组对一个由10名参与者组成的试点干预小组进行过程评估。在第三阶段，我们将进行一项小型随机试点试验，包括3个干预组和3个对照组(每个组10名参与者)。具体目标是：1.对黑人MSM进行定性的半结构化访谈，并与艾滋病服务组织(ASO)的工作人员和心理健康顾问进行接触，以开发针对黑人MSM中的不信任和歧视的干预模块。2.研究试点干预是否可以减少黑人男男性接触者对歧视的不信任和改善应对反应。3.探索试点干预对黑人男男性接触者心理健康、抗逆转录病毒治疗依从性和护理参与度的影响。我们的目标是使拟议的与文化相关的干预措施可以推广到已经制定的干预措施中，以改善艾滋病毒携带者对护理的遵守和参与。如果在未来由R01资助的研究中被证明是有效的，我们的干预措施将灵活地用于社区环境，例如已经在美国各地维持的现有艾滋病毒支持小组。

DESCRIPTION (provided by applicant): Black men who have sex with men (MSM) bear the greatest burden of HIV across all races/ethnicities and risk groups, accounting for ~40% of diagnoses among MSM of all races/ethnicities, and one-third among all men. Compared to other races/ethnicities, Blacks living with HIV are less likely to be diagnosed, to be engaged in care, and to receive and adhere to antiretroviral treatment (ART). Black MSM in particular show very low ART adherence. In this 3-year intervention development study, we propose to develop and pilot test a culturally relevant intervention to reduce medical mistrust and address discrimination among Black MSM living with HIV. Our work with Black MSM suggests that culturally relevant factors such as perceived discrimination and HIV- related medical mistrust (e.g., HIV "conspiracy beliefs," like "HIV is a manmade virus") contribute to disparities in HIV treatment behaviors, in some cases even more than factors known to be highly influential like depression and substance use. Black MSM living with HIV are at the nexus of 3 stigmatized social categories (HIV-serostatus, race, sexual orientation) from which they face discrimination, which in turn can lead to disparities by increasing detrimental stress responses related to poor self-control (maladaptive coping, poor health behaviors). Discrimination also fosters mistrust of public health entities, and suspicion of medical treatments. However, no interventions have been developed to overcome these culturally relevant barriers. In the proposed innovative community-based participatory research project, we will partner with a Black-MSM- serving AIDS service organization (ASO) with high success in engaging Black MSM in research. In Phase 1, we will conduct qualitative interviews with 30 Black MSM and 20 social service and mental health providers, and engage stakeholders in a community advisory process to obtain input on sustainable intervention components that can improve the effectiveness of service delivery. In Phase 2, we will conduct a process evaluation of one pilot intervention group of 10 participants, delivered via a community HIV support group. In Phase 3, we will conduct a small randomized pilot trial with 3 intervention groups and 3 control groups (10 participants each). The specific aims are to: 1. Conduct qualitative semi-structured interviews with Black MSM, and engage AIDS service organization (ASO) staff and mental health counselors, in order to develop intervention modules that address mistrust and discrimination among Black MSM. 2. Examine whether the pilot intervention can reduce mistrust and improve coping responses to discrimination among Black MSM. 3. Explore pilot intervention effects on mental health, antiretroviral treatment adherence, and engagement in care among Black MSM. Our goal is for the proposed culturally relevant intervention to be exportable to interventions already developed for improving adherence and engagement in care among people living with HIV. If shown to be effective in future R01-funded research, our intervention will be flexible for use in community settings, such as in existing HIV support groups already being sustained throughout the US.