A unified intervention for young gay and bisexual men's minority stress, mental health, and HIV risk

 描述(由申请人提供)：年轻的同性恋和双性恋男性(YGBM)经历抑郁、焦虑和药物使用问题的比例不成比例，他们是美国艾滋病毒感染的最高风险群体之一。不同的方法找到了YGBM暴露于少数族裔压力下这些健康差异的根源。事实上，少数民族压力、精神疾病发病率、药物使用和艾滋病毒风险相互助长，对YGBM的健康构成协同威胁。然而，没有任何干预措施解决少数民族压力、心理健康和药物使用问题，或它们对这一人群中艾滋病毒风险的联合影响。新近发现的少数民族应激 这些途径为改善YGBM的心理健康和降低艾滋病毒风险提供了明确的目标。其中一些过程本质上是认知和情感的，例如内在化的同性恋恐惧症和拒绝图式，而另一些过程的特征是行为回避，如性取向隐藏、不自信和冲动。强有力的证据表明，YGBM的每一种共同出现的健康风险都植根于这些少数群体的应激途径。初步研究。Desiem(有效技能为有效男性赋权)是一项为期10个疗程的技能建设干预措施，旨在通过解决少数族裔压力损害健康的潜在认知、情感和行为途径，减少YGBM的共生健康风险。我们创造了自尊(NIMH R34)，通过采用统一的认知-行为协议来促进抑郁/焦虑和高危YGBM中的少数民族压力应对。尊重旨在使少数群体压力的不利影响正常化，减少内化的同性恋恐惧症和排斥模式，并减少YGBM的不健康回避倾向(例如，在性行为中使用药物，不使用避孕套)。在一项初步的等待试验中，Deperem显著降低了YGBM的相关健康威胁范围，使其成为第一个同时改善YGBM的心理健康、物质使用和性风险结果的循证干预措施。方法：研究方法。确定(1)与社区心理健康治疗和艾滋病毒咨询和测试相比，(2)自尊是否通过其假想的认知、情感和行为少数群体应激过程发挥作用，以及(3)自尊在改善心理健康和避免艾滋病毒感染方面的成本效益。在基线、3个月、6个月和12个月时，我们的主要结果是“保护性行为”，即在没有PrEP或HIV主要伴侣的已知无法检测到的病毒载量的情况下的无套肛交。次要结果包括抑郁、焦虑、物质使用、性强迫和PrEP摄取-FDA自R34试点以来批准的。针对不同的问题部署独立的干预措施是目前减少YGBM的精神、行为和性健康问题的最昂贵的方法。一种单一的干预措施，通过减少跨越这些问题的常见少数群体应激途径来减少YGBM的抑郁、焦虑、药物使用和艾滋病毒风险，是目前孤立方法的有效、成本效益高的替代方案，并有望减少年轻男性中的性取向健康差距。

 DESCRIPTION (provided by applicant): Young gay and bisexual men (YGBM) disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in YGBM's exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to YGBM's health. Yet no intervention addresses minority stress, mental health and substance use problems, or their joint impact on HIV risk in this population. Recently discovered minority stress pathways offer clear targets for improving YGBM's mental health and reducing HIV risk. Some of these processes are cognitive and affective in nature, such as internalized homophobia and rejection schemas, whereas others are characterized by behavioral avoidance, such as sexual orientation concealment, unassertiveness, and impulsivity. Strong evidence suggests that each of YGBM's co-occurring health risks is rooted in these minority stress pathways. Preliminary Studies. ESTEEM (Effective Skills to Empower Effective Men) is a 10-session skills-building intervention designed to reduce YGBM's co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health. We created ESTEEM (NIMH R34), by adapting a unified cognitive-behavioral protocol to promote minority stress coping among depressed / anxious and at-risk YGBM. ESTEEM aims to normalize the adverse impact of minority stress, reduce internalized homophobia and rejection schemas, and decrease YGBM's unhealthy avoidance tendencies (e.g., substance use during sex, condom use non-assertion). In a preliminary waitlist trial, ESTEEM significantly reduced YGBM's spectrum of related health threats, making it the first evidence-based intervention to simultaneously improve mental health, substance use, and sexual risk outcomes in YGBM. Methods. To determine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing, (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes, and (3) ESTEEM's cost-effectiveness in terms of improved mental health and HIV infections averted. Our primary outcome at baseline, 3-, 6-, and 12-months is "protected sex," defined as condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake-FDA-approved since our R34 pilot. Deploying stand-alone interventions for separate problems represents the current, but most costly, method of reducing YGBM's mental, behavioral, and sexual health problems. A single intervention that reduces YGBM's depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems represents an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men.