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

项目总结 在美国的拉丁裔中，艾滋病毒预防持续存在差异，特别是那些移民 和性少数族裔男性(SMM)。拉美裔人倾向于在疾病后期被诊断出感染艾滋病毒(即进行检测) 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，只为拉丁裔SMM制定了一项干预措施，目前还没有一项 被开发或评估为PrEP摄取。基于科学前提和经验证据 耻辱是艾滋病毒差异的重要原因，我们建议进行一项随机对照试验 在为期8个疗程的认知行为治疗团体干预中，Siempre seguiré(我将继续被；命名 由社区利益攸关方在一首传达同性恋赋权的流行歌曲之后)，旨在增加 对跨界别身份污名的有效应对措施(与种族、移民身份和 (性少数认同)，目的是改善艾滋病毒预防的连续不断成果。 西门子公司在我们之前的试点工作中有很强的科学基础，我们发现拟议的干预措施 关键利益相关者可以接受，可行，并与改进的有效应对和 增加了对提供者和医疗保健的信任。具体目标是：(1)进行随机对照试验 Siempre seguiré，一个文化契合的认知行为治疗小组，为移民拉丁裔提供干预 性少数民族男性，测试对常规艾滋病毒检测和PrEP感染的干预效果；(2)检查 干预对艾滋病毒常规检测和PrEP摄取的影响机制，包括更有效的应对 (例如，减少内在化耻辱、预期耻辱和医疗不信任)；以及(3)进行成本- 干预效果分析。在已建立的社区-学术伙伴关系的背景下， 我们将对300名拉美裔移民SMM进行随机对照试验，其中150人随机接受干预，150人接受干预 注意控制组(一个以社区为基础、以健康为导向的支持小组，其课程与 干预条件在数量、时间和长度上)。参与者将在基线和3，6， 并在基线后12个月评估主要结果、潜在的调节因素、协变量和 版主。定期的艾滋病毒检测将与艾滋病毒检测结果的官方复印件和PrEP摄入量确认 将通过处方复印件、医疗记录和尿液测试得到确认。除了我们的 在我们自己的工作中，我们没有意识到有任何干预措施来解决因身份交叉而造成的耻辱 以改善健康状况。我们的研究与《健康人2020》是一致的，它建议 制定干预措施，以解决性少数群体中耻辱的影响。尽管结构上- 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至关重要 需要采取诸如西门子等干预措施，以减少污名对健康的直接影响。

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.