Defining intervention targets along pathways from cumulative stress and trauma to alcohol and HIV self-management among young people living with HIV (Project DEFINE)

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1 Young people living with HIV (YPLWH) are at high risk for poor HIV self-management, with 2 detectable viral load in 88%, and for hazardous alcohol use which can negatively impact the HIV 3 treatment and prevention cascade. Interventions to improve self-management of both alcohol 4 use and HIV care are critical but have had limited success in part due to the failure to account 5 for developmental and cultural characteristics unique to this population and stress and trauma 6 conferred by these characteristics. YPLWH are disproportionately racial, ethnic and sexual 7 minorities who experience higher rates of chronic and complex sources of stress and trauma 8 throughout their lives. Additionally, there are oppressive sources of stress and trauma related to 9 their racial, ethnic, sexual, and gender identities and HIV status, such as discrimination, 10 microaggressions, and stigma as a result of systemic structural and societal inequities. Although 11 stress has been linked to alcohol use and disease management, the pathways underlying these 12 links among YPLWH are poorly understood. Evidence suggests several modifiable factors that 13 may play a role in these indirect pathways. Stress has been associated with poor sleep health, 14 which may impact alcohol use and HIV self-management through the effect that poor sleep has 15 on emotion regulation. Behavioral regulation (e.g., decision-making, inhibitory control), is a core 16 component of self-management and may similarly mediate associations between cumulative 17 stress and alcohol use. Consistent with the overall goal of the P01 to improve self-management 18 of alcohol use and HIV care among YPLWH, this project would define developmentally and 19 culturally relevant, modifiable intervention targets in causal pathways between cumulative stress 20 and self-management outcomes among YPLWH, most of whom are subject to intersectional 21 sources of stress and trauma. Using innovative outreach methods, we will enroll 300 diverse 22 YPLWH age 18-29 to complete surveys of cumulative and intercurrent stress and trauma, sleep 23 health (i.e., survey and ecological momentary analysis [EMA] using an electronic sleep diary), 24 emotion and behavioral regulation, and substance use and HIV outcomes at baseline, 9 and 18 25 months. Further, minority YPLWH are less likely to be screened for or have access to available 26 interventions. In the fifth year, we will use a mixed methods approach in collaboration with 27 community members to develop a toolkit of adapted scalable measures for intervention 28 targeting. The resulting knowledge and tools have the potential to improve health outcomes and 29 quality of life for underserved youth who often may not benefit from advances in HIV care 30 through addressing factors uniquely relevant to them.