Still Climbin': A Randomized Controlled Trial of an Intervention to Improve Coping with Discrimination, Address Medical Mistrust, and Reduce Health Disparities among Black Sexual Minority Men

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PROJECT SUMMARY/ABSTRACT Black men, especially Black sexual minority men (SMM), are negatively affected by health and healthcare disparities: They show worse outcomes for preventable conditions and preventable complications from chronic conditions, and are less likely to engage with healthcare than are White men and women. Based on evidence and theory that discrimination contributes meaningfully to disparities, we are conducting a randomized controlled trial (RCT) of an 8-session culturally congruent cognitive behavior therapy group intervention, Still Climbin’, which aims to increase effective coping responses to intersectional stigma and discrimination, and reduce medical mistrust among Black SMM, with the goal of improving healthcare engagement and receipt of evidence-based preventive care. Still Climbin’ 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. The parent grant specific aims are: (1) To conduct an RCT to test the effects of Still Climbin', a culturally congruent cognitive behavior therapy group intervention, on healthcare engagement and receipt of evidence-based preventive care among Black sexually minority men; (2) To examine mechanisms of the intervention’s effects on improved healthcare engagement and receipt of evidence-based preventive care, including more effective coping skills and reduced medical mistrust; and (3) To examine potential moderators of the intervention’s effects. In the context of established community-academic partnerships, we will conduct the RCT with 300 Black SMM, randomizing 150 to the intervention group and 150 to a wait-list control group. Participants will complete surveys at baseline and 4-, 8-, and 12-months post-baseline to assess the primary outcomes, and potential mediators, covariates, and moderators. Healthcare engagement, receipt of evidence- based care, and health conditions will be verified with medical records. The proposed supplement study would increase the sub-sample size of older Black SMM living with HIV in the parent study by 70 participants to: (1) Examine the correlates of mental and physical health outcomes, including resilience factors (e.g., social support, effective coping) and risk factors (e.g., intersectional stigma, ineffective coping, loneliness), using an expanded baseline sample of older Black SMM living with HIV; and (2) Evaluate Still Climbin’ intervention effects on risk and resilience factors related to mental and physical health outcomes among older Black SMM living with HIV. We also will explore preliminary effects on HIV viral load suppression. With the exception of our own work, we are not aware of any interventions that address coping with discrimination from intersectional identities in order to improve health outcomes among Black SMM. Although structural-level interventions are critical for reducing societal discrimination as a long-term strategy, individual-level interventions—such as Still Climbin’—are needed in tandem to reduce discrimination’s immediate health effects.