Intervention to Reduce Internalized Stigma (IRIS) among People Living with HIV who use Substances

摘要 与物质使用障碍(SUD)相关的耻辱的不同方面(预期的、实施的、内化的) 艾滋病毒呈阳性状态阻碍了药物使用的停止和艾滋病毒健康后果，包括 抗逆转录病毒治疗依从性和病毒载量抑制1-6，尽管周围普遍存在公共污名 两者，个人都可以学习减少其内化和减轻污名对其健康的负面影响。 然而，促进这一点的干预在已出版的文献中是不存在的。 为此，我们建议采用基于证据的污名减少影响干预措施，结束自我 耻辱(ESS)以减少耻辱及其对健康的负面影响。ESS已显示出降低 在经历心理健康状况的人群中内化和预期的污名。 团体干预，使用认知行为治疗策略和社会认知理论 构建，采用教学学习和互动活动，以促进减少内部化和 意料之中的耻辱。 拟议研究的目的是调整ESS干预措施，使其适用于艾滋病毒携带者 也有阿片类药物使用障碍(OUD)和/或可卡因使用障碍(CUD)。在第一年，我们将使用 迭代流程，从对服务交付关键信息人员和与之共处的人进行形成性访谈开始 PLWH以OUD和/或CUD结束，并以连续两项针对研究人群的试点研究结束。穿过 在这一过程中，干预内容将针对该人群进行调整，干预提供也将进行调整 用于通过基于网络的平台的虚拟格式。然后，在2-3年，一项小型随机临床试验 适用于PLWH伴物质使用障碍的最终自我污名干预(ESS-HSU)将是 对70名参与者进行了调查，以确定其可行性和可接受性，并收集了以下数据 近期结果包括内在化和预期的污名、抑郁症状、焦虑和感知 与柱头相关的压力。我们还将测量远端结局，包括ART依从性、病毒载量和 6个月随访时药物使用情况(SU)。 ESS-HSU干预通过减少负面影响，有可能对公众健康产生很大影响 对普遍的公众对HIV血清阳性的污名所造成的内在化和预期的污名 SU的状况和SUD对HIV健康结局和戒毒的影响。ESS-HSU将是第一个虚拟干预 这种类型的药物将在随机临床试验中进行评估。如果结果是有希望的，我们将寻求R01资金用于 对这一创新干预措施进行全面测试，以确定其对一系列健康结果的影响 描述干预效果的机制。

ABSTRACT Different facets of stigma (anticipated, enacted, internalized) associated with substance use disorder (SUD) and with HIV positive status impede cessation of substance use and HIV health outcomes including antiretroviral therapy adherence and viral load suppression.1-6 Although public stigma is pervasive surrounding both, individuals can learn to reduce its internalization and mitigate stigma’s negative impacts on their health. However, interventions promoting this are non-existent in the published literature. To this end, we propose to adapt an evidence-based stigma-impact reduction intervention, Ending Self- Stigma (ESS) to reduce stigma and its negative impacts on health. ESS has shown efficacy in reducing internalized and anticipated stigma in populations experiencing mental health conditions.7 The 9-session group-based intervention, which uses cognitive behavioral therapy strategies and social cognitive theory constructs, employs didactic learning and interactive activities to facilitate reductions in internalized and anticipated stigma. The purpose of the proposed study is to adapt the ESS intervention for people living with HIV (PLWH) who also have opioid use disorder (OUD) and/or cocaine use disorder (CUD). In the first year, we will use an iterative process that starts with formative interviews with service delivery key informants and people living with PLWH with OUD and/or CUD, and ends with two successive pilot studies with the study population. Through this process, intervention content will be adapted for this population and intervention delivery will be adapted for a virtual format via a web-based platform. Then, in years 2-3, a small randomized clinical trial of the resulting Ending Self-Stigma intervention adapted for PLWH with Substance Use disorder (ESS-HSU) will be conducted with 70 participants to determine its feasibility and acceptability in addition to collecting data on proximal outcomes including internalized and anticipated stigma, depressive symptoms, anxiety and perceived stress associated with stigma. We will also measure distal outcomes including ART adherence, viral load and substance use (SU) at 6-month follow-up. The ESS-HSU intervention has the potential for high public health impact by reducing the negative effects of internalized and anticipated stigma resulting from the pervasive public stigmatization of HIV seropositive status and SUD on HIV health outcomes and cessation of SU. ESS-HSU would be the first virtual intervention of this type to be evaluated in a randomized clinical trial. If results are promising, we will seek R01 funding for a full-scale test of this innovative intervention to determine its effects on a range of health outcomes and characterize mechanisms of intervention effects.