Promoting Reductions in Intersectional Stigma to Improve HIV Testing and PrEP Use Among Latino Sexual Minority Men

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PROJECT SUMMARY HIV prevention continuum disparities persist among Latinos in the U.S., especially those who are immigrants and sexual minority men (SMM). Latinos tend to be diagnosed with HIV (i.e., tested) at a later disease stage and use pre-exposure prophylaxis (PrEP) at much lower rates than do Whites. However, of the existing evidence-based HIV prevention interventions, only one was developed for Latino SMM, and none have yet been developed or assessed for PrEP uptake. Based on the scientific premise and empirical evidence that stigma contributes meaningfully to HIV disparities, we propose to conduct a randomized controlled trial (RCT) of an 8-session cognitive behavior therapy group intervention, Siempre Seguiré (“I will continue being”; named by community stakeholders after a popular song conveying gay empowerment), which aims to increase effective coping responses to stigma from intersectional identities (related to ethnicity, immigration status, and sexual minority identity) among Latino SMM, with the goal of improving HIV prevention continuum outcomes. Siempre Seguiré has a strong scientific basis in our prior pilot work, which found that the proposed intervention is acceptable to key stakeholders, feasible to conduct, and associated with improved effective coping and increased trust in providers and healthcare. The specific aims are: (1) To conduct a randomized controlled trial of Siempre Seguiré, a culturally congruent cognitive behavior therapy group intervention for immigrant Latino sexual minority men, to test intervention effects on regular HIV testing and PrEP uptake; (2) To examine mechanisms of intervention effects on regular HIV testing and PrEP uptake, including more effective coping (e.g., reduced internalized stigma, anticipated stigma, and medical mistrust); and (3) To conduct a cost- effectiveness analysis of the intervention. In the context of an established community-academic partnership, we will conduct the RCT with 300 immigrant Latino SMM, randomizing 150 to the intervention and 150 to an attention control group (a community-based wellness-oriented support group, with sessions matched to the intervention condition in number, timing, and length). Participants will complete surveys at baseline and 3, 6, and 12 months post-baseline to assess the primary outcomes, potential mediators, covariates, and moderators. Regular HIV testing will be confirmed with official copies of HIV testing results, and PrEP uptake will be confirmed through copies of prescriptions, medical records, and urine testing. With the exception of our own work, we are not aware of any interventions that address coping with stigma from intersecting identities in order to improve health outcomes. Our research is consistent with Healthy People 2020, which recommends developing interventions to address effects of stigma among sexual minority individuals. Although structural- level interventions are critical for reducing societal stigma as a long-term strategy, individual-level interventions—such as Siempre Seguiré—are needed in tandem to reduce stigma’s immediate health effects.