Yale University

Adapting an evidence-based intervention for stigma-related stress, mental health, and HIV risk for MSM of color in small urban areas

Funder: National Institute of Mental Health
Project period: 02/12/2018 - 02/11/2019
Grant Type: Pilot Project

Abstract Text:

Gay, bisexual, and other men who have sex with men (MSM) represent the only major risk group for whom new incident cases of HIV are increasing in the US; indeed, MSM of color living in the US represent one of the most at-risk populations in the world. At current rates, 1 in 3 MSM of color in the US will be diagnosed with HIV in their lifetime. While MSM of color who reside in small urban areas of the US are at particular risk of acquiring HIV, the majority of preventive interventions have only been developed and tested in major cities. Our research shows that MSM of color living in small urban areas face distinct barriers to psychosocial health, including a loss of physical “safe” gay spaces and community visibility as a result of increasing technology use, and exclusion from the limited remaining gay spaces because of segregation and racism. Through psychological experiences of social exclusion, low self-worth, and hopelessness, sexual and racial stigma drive mental health problems (e.g., depression, substance abuse), which in turn serve as a known risk factor for HIV infection among syndemically affected populations. The proposed research will create and deliver a group-based intervention to improve stigma coping and mental health to provide MSM of color with psychological resources against HIV transmission in small urban areas. This intervention addresses three gaps in current approaches. First, although our team has created the first evidence-based intervention that reduces MSM’s HIV risk behavior by improving stigma coping and mental health, this intervention has been developed and delivered in major cities. Second, although about half of the participants in our original intervention trials were MSM of color, the treatment has not specifically addressed the intersecting sources of stigma that MSM of color face toward both their sexual and racial identities. Third, because this treatment has only been delivered in one-on-one settings, it has not taken advantage of a group delivery format to promote healthy peer norms, role modeling, and social connections that might be particularly important in the social and sexual networks of MSM living in small urban areas. Based on our recent interviews with 29 MSM living in New Haven and Hartford (n = 16 MSM of color), we will adapt the existing intervention to: 1) address HIV risks in small urban areas, 2) focus on intersecting stigmas facing MSM of color, and 3) take advantage of the unique ability of groups to foster healthy norms and connections. We will then deliver the intervention to 20 MSM (n = 10 HIV-negative, n = 10 HIV-positive), who will complete pre-and post-test assessments of stigma, mental health, and HIV risk. This project integrates expertise in culturally-sensitive evidence-based interventions for MSM’s HIV risk into a community-based HIV prevention and care context at the Fair Haven Community Health Center, where the intervention will be delivered to the existing patient population. This community-research alliance maximizes this project’s ability for widespread community implementation to improve stigma coping and mental health en route to reducing HIV-transmission risk among one of the highest-risk populations in our region and the world.