Feasibility, acceptability, and preliminary efficacy of an adapted group-based and online HIV prevention intervention for gay men in the US

Evidence shows that gay men may be particularly likely to leave their countries, whether by choice or force. Among the general gay population, stigma at multiple levels, and subsequent stress reactions contribute to co-occurring HIV and mental health risks. Stressors negatively influence gay men’ HIV risks and mental health. In the US, the experiences of gay men born outside of the US may be different from those born in the US, in particular because of their exposure to high stigma, high HIV risk, and poor mental health in their home countries.

Despite this confluence of risks, there are no interventions that address the magnitude of intersectional stigma on HIV risk and mental health among gay men born outside of the US. Theoretically informed interventions can buffer against the health risks of stigma when tailored to address stress reactions among gay men; however, most interventions do not account for multiple and intersecting sources of stigma, and none focus on stigma related to being born outside of the US. Our intervention, ESTEEM (Effective Skills to Empower Effective Men), a stress focused cognition behavioral therapy (CBT) has shown strong efficacy in improving mental, behavioral, and HIV (e.g., condom use and pre-exposure prophylaxis [PrEP]) health outcomes among gay men. Our preliminary interviews in the US with Arab gay men born outside of the US (N=16) suggest intervention preferences for an online group delivery format that connects gay men with shared experiences, irrespective of their current geographical location in the US, thus facilitating greater reach and effective recruitment, to be led by trained counselors that share similar identities.

Following the ADAPT-ITT model, this study aims to adapt and pilot-test the ESTEEM intervention to target the underlying mechanisms linking gay men’ intersectional stressors to co-occurring HIV risks and poor mental health outcomes. In Aim 1, we will seek input from multiple stakeholders using qualitative interviews with 15 mental health experts and 15 Arab gay men born outside of the US and adapt ESTEEM for online group delivery and for Arab gay men in the US. In Aim 2, we will randomize 60 participants to receive 10 weekly, 90-minute online-based group sessions, either immediately (immediate intervention group, n=30) or after 3 months (waitlist control group, n=30) to evaluate intervention acceptability and feasibility and to determine preliminary efficacy on primary (HIV-risk behavior) and secondary (mental health) outcomes.

Grant Number: 1R34MH134603-01A1
NIH Institute/Center: NIH
Principal Investigator: Sarah Abboud