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

项目摘要 在美国的拉丁美洲人中，艾滋病毒预防连续性的差距仍然存在，尤其是那些移民 性少数群体（SMM）拉丁美洲人往往被诊断出患有艾滋病毒（即，测试）在后期疾病阶段 使用暴露前预防（PrEP）的比率比白人低得多。然而，现有的 基于证据的艾滋病毒预防干预措施，只有一个是为拉丁美洲SMM开发的，目前还没有一个 已开发或评估PrEP摄取。基于科学前提和经验证据， 耻辱感对艾滋病差异有意义，我们建议进行一项随机对照试验（RCT） 一个8个疗程的认知行为治疗小组干预，Siempre Seguiré（“我将继续存在”;名为 由社区利益相关者在一首传达同性恋赋权的流行歌曲后发起），旨在增加 有效应对来自交叉身份（与种族，移民身份， 性少数群体身份），以改善艾滋病毒预防连续成果的目标。 Siempre Seguiré在我们之前的试点工作中有很强的科学基础，该工作发现， 为主要利益攸关方所接受，可行，并与改进的有效应对相关， 增加对供应商和医疗保健的信任。具体目的是：（1）进行随机对照试验 Siempre Seguiré，一个针对拉丁裔移民的文化一致的认知行为治疗小组干预 性少数男性，以测试干预措施对定期艾滋病毒检测和PrEP摄取的影响;（2）检查 干预机制对定期艾滋病毒检测和PrEP吸收的影响，包括更有效的应对 (e.g.,减少内化的耻辱，预期的耻辱，和医疗不信任）;和（3）进行成本- 干预的有效性分析。在已建立的社区-学术伙伴关系的背景下， 我们将对300名拉丁裔SMM移民进行随机对照试验，其中150人随机分配到干预组，150人随机分配到 注意力控制组（一个以社区为基础的健康为导向的支持小组，会议与 在数量、时间和长度上的干预条件）。参与者将在基线和第3，6， 和基线后12个月，以评估主要结局、潜在介质、协变量和 版主。定期的艾滋病毒检测将通过艾滋病毒检测结果的正式副本和PrEP摄取来确认 将通过处方、医疗记录和尿检的复印件进行确认。除了我们的 在我们自己的工作中，我们不知道有任何干预措施可以解决来自交叉身份的耻辱感， 以改善健康状况。我们的研究与《健康人群2020》一致，该研究建议 * 制定干预措施，以解决性少数群体遭受耻辱的影响。虽然结构- 作为一项长期战略，个人层面的干预措施对于减少社会耻辱感至关重要， 需要采取干预措施，如Siempre Seguiré，以减少耻辱感对健康的直接影响。

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.