Developing and Testing a Novel Multidimensional Stigma-Resilience Measure for Stigma Reduction Research with Black Men Who Have Sex with Men

点击翻译按钮获取中文摘要

ABSTRACT Black men who have sex with men (BMSM) continue to experience disproportionate burdens of HIV compared to other MSM subgroups in the US. This disparity is exacerbated by the multilevel intersectional stigmas that BMSM face, including those based on race, same-sex attraction/behavior, and presumed HIV-positive status, which results in high levels of psychological distress and poor HIV prevention outcomes. Resilience is a critical component in studies to mitigate the negative impact of multilevel intersectional stigmas on HIV prevention uptake among BMSM. However, existing resilience measures are designed for non-marginalized populations and are inadequate for assessing BMSM's resilience to multilevel intersectional stigmas. To address this gap, we propose to develop a novel, BMSM-specific, multidimensional stigma-resilience scale that captures the nuanced resiliency mechanisms countering intersectional stigmas across multiple socioecological levels. The proposed study will be conducted in Nashville, an HIV hotspot in the Southern US, where growing HIV burdens and intersectional stigmas among BMSM have been identified. The study has two specific aims. In Aim 1, we will define the mechanisms of multidimensional resilience that BMSM use to counter intersectional stigmas. We will conduct in-depth interviews with 30 HIV-negative BMSM in Nashville, guided by a conceptual framework that integrates the Socioecological Model, Resilience Theory, and Intersectionality Framework. We will explore how resilience is developed, manifested, and implemented to overcome intersecting forms (e.g., internalized, enacted, experienced, and anticipated) and types (e.g., stigma against racism, homosexuality, and presumed HIV status) of stigmas across multiple socioecological levels (e.g., individual, interpersonal, community and healthcare). Aim 2 will necessitate an iterative and systematic BMSM community engagement process to develop and validate a new multidimensional stigma-resilience measure tailored for BMSM. Insights from Aim 1 will help inform the adaptation of an existing scale (e.g., Multilevel Resilience Measure for Black Adults Living with HIV) to be contextually appropriate and stigma-focused for BMSM. We will then assess face validity and cultural relevancy through cognitive interviews with 10 BMSM, followed by conducting psychometric analyses with 250 BMSM to test the new scale's reliability (e.g., internal consistency) and validity (e.g., convergent, divergent, and predictive validity). The proposed study is significant in providing a robust, culturally-tailored stigma-resilience measure, which will inform our future R34/R01 study to develop and evaluate a multilevel resilience-based intervention to mitigate intersectional stigmas and HIV prevention uptake among BMSM. Additionally, the new BMSM Multidimensional Stigma-Resilience Scale will provide the groundwork for future studies to refine and adapt the scale for resilience-focused research conducted with other marginalized populations (e.g., Latino/Hispanic MSM; transwomen of color).