Developing efficient intervention technologies to reduce stigma-related stress, mental health problems, and HIV risk among young Chinese MSM

项目摘要 背景中国男同性恋、双性恋和其他男男性行为者（MSM）的艾滋病感染率 从2003年的不到1.0%上升到2016年的9.2%。缺乏行动将导致1/6的中国男男性接触者 到2025年感染艾滋病毒;大多数将是年轻人（YMSM）。污名化加剧了中国的艾滋病流行， YMSM。我国男青年缺乏平等的权利和法律的保护，身份隐瞒是规范的， 转化疗法很普遍中国人的孝道价值观和规范的一致性进一步使YMSM紧张。 这种耻辱感引起了少数人的压力反应，包括身份隐瞒，内化同性恋， 以及对基于身份的拒绝的敏感性。少数民族的压力和相关的不良心理健康都会损害 YMSM的艾滋病毒预防通过避免应对，低自我价值，冲动，和不自信。我们的团队 已经创建了第一个针对YMSM有效性的干预测试，以解决这些少数压力反应 和相关过程。这种认知行为（CBT）干预，称为ESTEEM，显示出强大的初步 在少数民族压力，心理健康和艾滋病毒风险行为的有效性。然而，ESTEEM是在美国开发的， 目前需要10次1小时的会议，无法在 中国现在，我们研究的进展使我们能够为广泛的ESTEEM做好准备。初步 问题研究首先，我们通过8个阶段的适应，在文化上适应了中国YMSM的亲自ESTEEM 与YMSM和利益相关者（n=56）的过程，包括与中国YMSM（n=8）的小型开放试点。第二、 我们与瑞典的同事--基于互联网的CBT（iCBT）的世界领导者--合作创建了一个iCBT ESTEEM版本。iCBT结合了自我引导的移动的平台， 练习和家庭作业，比面对面的ESTEEM少需要80%的辅导员时间。在一个小型美国飞行员 （n=10），iCBT ESTEEM是高度功能性的。我们结合这些进展来开发中国ESTEEM iCBT -一个高效的，私人干预，解决少数民族的压力和心理健康作为艾滋病毒 预防目标。(1)转换我们最近创建的中文ESTEEM面对面材料（例如，手动， 讲义）到iCBT内容（例如，自我指导练习，视频），并确保其理解（n=10 YMSM）。 (2)测试中国ESTEEM iCBT降低高危YMSM过去90天HIV风险的初步疗效 行为，对每周自我监测控制。(3)确定实施障碍和促进因素 通过分析Aim 2数据（例如，咨询师忠诚度）和定性访谈， 目标2参与者（n=20），顾问（n=4），政府利益相关者（例如，中国疾控中心、医疗门诊工作人员， n=12）和执行伙伴（例如，艾滋病毒预防非政府组织，LGBTQ中心，n=12）。在发展一个高度 有效的平台，传播我们的少数民族压力心理健康干预，我们也定位自己， 持续的未来合作，包括研究这种干预措施的最终采用， 在中国和其他受艾滋病毒严重影响的中低收入国家，

PROJECT SUMMARY Background. HIV prevalence among gay, bisexual, and other men who have sex with men (MSM) in China has increased from less than 1.0% in 2003 to 9.2% in 2016. Lack of action will lead to 1 in 6 Chinese MSM being infected with HIV by 2025; the majority will be young (YMSM). Stigma fuels China’s HIV epidemic among YMSM. Chinese YMSM face a lack of equal rights and legal protections, identity concealment is normative, and conversion therapy is widespread. Chinese values of filial piety and norm conformity further strain YMSM. This stigma gives rise to minority stress reactions, including identity concealment, internalized homonegativity, and sensitivity to identity-based rejection. Both minority stress and associated poor mental health compromise YMSM’s HIV prevention through avoidance coping, low self-worth, impulsivity, and unassertiveness. Our team has created the first intervention tested for efficacy with YMSM that addresses these minority stress reactions and related processes. This cognitive-behavioral (CBT) intervention, called ESTEEM, shows strong preliminary efficacy across minority stress, mental health, and HIV risk behavior. Yet, ESTEEM was developed in the US and currently requires in-person delivery of 10 1-hour sessions, precluding widespread implementation in China. Now, advancements in our research allow us to prepare ESTEEM for broad reach. Preliminary Studies. First, we culturally adapted in-person ESTEEM for Chinese YMSM across an 8-stage adaptation process with YMSM and stakeholders (n=56), including a small open pilot with Chinese YMSM (n=8). Second, we worked with our colleagues in Sweden – world leaders in internet-based CBT (iCBT) – to create an iCBT version of ESTEEM. iCBT combines a self-guided mobile platform with brief counselor feedback and online exercises and homework, requiring 80% less counselor time than in-person ESTEEM. In a small US pilot (n=10), iCBT ESTEEM was highly functional. We incorporate these advances to develop Chinese ESTEEM iCBT – a highly efficient, private intervention that addresses minority stress and mental health as HIV prevention. Aims. (1) Transform our recently created Chinese ESTEEM in-person materials (e.g., manual, handouts) into iCBT content (e.g., self-guided exercises, videos) and ensure its comprehension (n=10 YMSM). (2) Test the initial efficacy of Chinese ESTEEM iCBT for reducing at-risk YMSM’s past-90-day HIV-risk behavior, against a weekly self-monitoring control. (3) Identify implementation barriers and facilitators of Chinese ESTEEM iCBT through analysis of Aim 2 data (e.g., counselor fidelity) and qualitative interviews with Aim 2 participants (n=20), counselors (n=4), government stakeholders (e.g., Chinese CDC, medical clinic staff, n=12), and implementing partners (e.g., HIV-prevention NGOs, LGBTQ centers, n=12). In developing a highly efficient platform to disseminate our minority stress-mental health intervention, we also position ourselves for sustained future collaboration, including on research to study the ultimate uptake of this intervention in established settings across China and other low/middle-income countries severely affected by HIV.