Adaptation and feasibility of Many Men Many Voices (3MV), an HIV prevention intervention to reduce intersectional stigma and increase HIVST among YSMM residing in Ghanaian slums

项目摘要 年轻的性少数族裔男子(YSMM)占#年性少数族裔男子艾滋病毒流行率的63%(18%)。 加纳，全国患病率为2%。我们之前包括加纳基督教青年会在内的研究表明， 内在化和人际交叉性(艾滋病毒、性少数、性别表达)污名和不足 艾滋病毒知识阻碍了SMM中的艾滋病毒检测。对于贫民窟中的那些人来说，贫民窟中的社会和经济障碍 社区可以与跨部门的耻辱交织在一起，以加剧艾滋病毒感染的风险并阻止 在基督教青年会中进行艾滋病毒检测。艾滋病毒自我检测(HIVST)具有增加检测、提供隐私和 方便。然而，由于专业知识不足和跨部门的原因，基督教青年会对它的接受仍然令人望而生畏 耻辱。我们建议将《多人多声》(3 MV)改编成改编版，名为Lafiya(本地 单词意思是健康)，以解决交叉耻辱和增加基督教青年会中的HIVST。而3MV则有 在SMM中增加艾滋病毒检测的有效性，适应贫民窟中的YSMM将显示其适用于 青年和基督教青年会在加纳和南沙不同的地理和社会经济背景下。拉菲亚会的 也扩大了3 MV的效用，通过利用关于交叉污名和 HIVST选项，它是在原始版本之后推出的。在ADAPTT-IT模式的八个步骤指导下，我们 将实现以下目标。1)评估跨部门耻辱和实施艾滋病毒/艾滋病综合管理方案的选择 YSMM，2)在Lafiya上适应3 MV，以解决YSMM之间的柱头交叉和HIVST，以及3)测试 接受，可行性，适当性和初步效果的拉菲亚解决交叉污名和 增加HIVST的摄取率。在目标1中，我们将深入访谈基督教青年会(n=20)、提供者(n=20)； 诊所=10个，与基督教青年会合作评估经验的社区组织(=10个) 在基督教青年会中实施艾滋病毒自我检测的跨部门耻辱和选择。在目标2中，我们将进行 进行总结性分析，以解释AIM1的结果，以确定适合和修改以使3 MV适应现实 在加纳贫民窟建立基督教青年会。在目标3中，我们将测试可接受性、可行性、适当性和初步 通过在基督教青年会(n=60)中进行试点的事前干预来提高拉菲亚的疗效。基督教青年会将收到拉菲亚 如果HIVST检测呈阳性，还可以选择接受HIVST，并联系ART提供者寻求支持。 我们将评估主要结果(可接受性、可行性、适当性)和次要结果 (初步疗效)使用基线、即刻和干预后3个月的调查。这项研究将告知 拉菲亚提高HIVST疗效的随机分组对照试验研究 YSMM。这些发现将为跨部门减少耻辱和HIVST实施战略提供参考 YSMM、贫民窟、SSA和其他不同环境中的高危人群。

Project Summary Young sexual minority men (YSMM) make up 63% of the HIV prevalence (18%) among sexual minority men in Ghana, which has a 2% national prevalence rate. Our previous studies that included YSMM in Ghana show that internalized and interpersonal intersectional (HIV, sexual minority, gender expression) stigma and insufficient HIV knowledge impedes HIV testing among SMM. For those in slums, the social and economic barriers in slum communities can intertwine with intersectional stigma to exacerbate the risk of HIV infections and discourage HIV testing among YSMM. HIV self-testing (HIVST) has the efficacy of increasing testing, providing privacy and convenience. Yet its uptake among YSMM remains daunting due to insufficient expertise and intersectional stigma. We propose to adapt the Many Men, Many Voices (3MV) to a modified version dubbed LAFIYA (local word meaning wellness) to address intersectional stigma and increase HIVST among YSMM. Whereas 3MV has the efficacy to increase HIV testing among SMM, adaptation for YSMM in slums will show its applicability to young adults and YSMM in a different geographic and socioeconomic context in Ghana and SSA. LAFIYA will also extend 3MV’s utility for HIV prevention by utilizing scientific advancements around intersectional stigma and HIVST options, which came after the original version. Guided by the eight steps of the ADAPTT-IT model, we will implement the following aims. 1) Assess intersectional stigma and options for HIVST implementation among YSMM, 2) Adapt 3MV to LAFIYA to address intersectional stigma and HIVST among YSMM, and 3) Test acceptance, feasibility, appropriateness, and preliminary efficacy of LAFIYA to address intersectional stigma and increase HIVST uptake. In Aim 1, we will conduct in-depth interviews with YSMM (n= 20), providers (n=20); clinics=10, and community-based organizations (=10) that work with YSMM to evaluate experiences of intersectional stigma and options for implementing HIV self-testing among YSMM. In Aim 2, we will conduct a summative analysis to interpret findings from AIM1 to identify fit and modifications to tailor 3MV to the realities of YSMM in Ghanaian slums. In AIM 3, we will test the acceptability, feasibility, appropriateness, and preliminary efficacy of LAFIYA through a pilot pre-post intervention among YSMM (n=60). The YSMM will receive the LAFIYA intervention and have the option to pick up HIVST and contact of ART providers for support if they test positive. We will assess primary outcomes (acceptability, feasibility, appropriateness) and secondary outcomes (preliminary efficacy) using baseline, immediate, and 3-month post-intervention surveys. The study will inform the preparation of a clustered randomized control trial to measure LAFIYA’s efficacy in increasing HIVST among YSMM. The findings will inform intersectional stigma reduction and HIVST implementation strategies among YSMM, slums, SSA, and other high-risk populations in different settings.