Integrating Mental Health into HIV Prevention and Care Continua Services and Systems for Young GBMSM in Kenya: A Community-Led Participatory Approach

项目摘要 年轻的男同性恋者、双性恋者和其他男男性行为者(Y-GBMSM)感染艾滋病毒的风险更高 在肯尼亚，他们是《肯尼亚艾滋病战略框架II》(2020/21-2024/25)中的关键人群。Y-GBMSM 经历获得高质量艾滋病毒预防和护理服务的多重障碍，并报告说 医务人员实施的歧视和暴力行为。同性行为的刑事化和 社会对LGBTQ人群的负面态度导致了持续的耻辱和歧视。 肯尼亚的Y-GBMSM也报告了不成比例的高水平的精神健康(MH)挑战，部分原因是 持续的歧视和暴力。心理健康挑战与艾滋病毒风险增加之间的关联 在肯尼亚的Y-GBMSM中，已经记录了行为和艾滋病毒阴性健康后果。相反， 积极的心理健康因素与改善这一人群的艾滋病毒结局有关，无论 他们的艾滋病毒状况。鉴于MH挑战和艾滋病毒预防之间的多方面联系 在肯尼亚Y-GBMSM的治疗结果中，研究人员建议将MH和MH 艾滋病毒服务，因为这种整合改善了患者和服务的交付结果。在这份R-21申请中，我们 将利用参与性行动研究方法：a)探讨心理健康如何面临负面挑战 在肯尼亚基苏木，通过艾滋病毒预防和艾滋病毒护理连续开展对Y-GBMSM的影响进展； B)制定框架，将男童保健宣传与艾滋病毒预防和护理连续服务相结合-- 基苏木的GBMSM；以及c)为精神健康促进方案的组成部分制定蓝图，可以 在四个社会生态层面纳入青年会艾滋病毒预防和护理连续服务： 个人、团体、诊所/组织和社区。这项拟议的研究将利用分析 已经收集的数据是正在进行的一项研究的一部分，目前正在测试艾滋病毒预防/心理社会PrEP 支持对基苏木Y-GBMSM的干预[R34-MH-118950-01：HARPER，M-PI]，并将收集原始数据 以社区特写、个人深入采访和焦点小组讨论的形式，与Y- GBMSM和服务提供商。我们有一支多学科的心理健康和艾滋病毒核心研究团队 来自肯尼亚和美国的专家在基苏木合作了5年多，我们将积极 Y-GBMSM通过我们的社区参与式发展团队和服务参与 通过我们的服务提供商开发团队为提供商提供服务。这项研究建立在哈珀15年多的工作基础上 在肯尼亚与Y-GBMSM合作。我们预计这项研究的结果将产生很大的影响，因为它既创造了一个 可用于探讨不同心理健康和艾滋病毒模式的优缺点的框架 Y-GBMSM的服务集成，以及可以 在四个不同的社会生态层面纳入艾滋病毒预防和护理服务。这些数据将 对撒哈拉以南非洲其他地区的类似工作有影响，并为国内努力提供信息。

Project Summary Young gay and bisexual men and other men who have sex with men (Y-GBMSM) are at elevated risk for HIV in Kenya, and are a Key Population in the Kenya AIDS Strategic Framework II (2020/21-2024/25). Y-GBMSM experience multiple barriers to accessing quality HIV prevention and care services, and report high levels of discrimination and violence perpetrated by healthcare workers. Criminalization of same-sex behavior and negative societal attitudes toward LGBTQ people lead to persistent experiences of stigma and discrimination. Y-GBMSM in Kenya also report disproportionately high levels of mental health (MH) challenges, in part due to persistent discrimination and violence. Associations between mental health challenges and increased HIV risk behaviors and negative HIV health outcomes have been documented among Y-GBMSM in Kenya. Conversely, positive mental health factors are associated with improved HIV outcomes for this population regardless of their HIV status. Given the multi-faceted associations between MH challenges and HIV prevention and treatment outcomes among Y-GBMSM in Kenya, researchers have recommended the integration of MH and HIV services, as such integration improves patient and service delivery outcomes. In this R-21 application, we will utilize a participatory action research approach to: a) explore how mental health challenges negatively influence progression through both the HIV prevention and HIV care continua for Y-GBMSM in Kisumu, Kenya; b) develop a framework for integrating MH promotion with HIV prevention and care continua services for Y- GBMSM in Kisumu; and c) develop blueprints for mental health promotion program components that could be integrated into HIV prevention and care continua services for Y-GBMSM at four socio-ecological levels: individual, group, clinic/organization, and community. This proposed study will take advantage of analyzing data already collected as part of an ongoing study currently testing an HIV prevention/psychosocial PrEP support intervention for Y-GBMSM in Kisumu [R34-MH-118950-01:Harper,M-PI], and will collect primary data in the form of community charrettes, individual in-depth interviews, and focus group discussions with both Y- GBMSM and service providers. We have a multi-disciplinary Core Research Team of mental health and HIV experts from Kenya and the U.S. that have worked together in Kisumu for 5+ years, and we will have active engagement from Y-GBMSM through our Community Participatory Development Team and from service providers through our Service Providers Development Team. The study builds on Harper's 15+ years working with Y-GBMSM in Kenya. We anticipate that results from this study will have high impact by creating both a framework that can be used to explore advantages/disadvantages of different models of mental health and HIV service integration for Y-GBMSM, and blueprints for mental health promotion components that can be integrated into both HIV prevention and care services at four different socio-ecological levels. Such data will have implications for similar work in other sub-Saharan African settings, as well as inform domestic efforts.