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Pilot Randomized Controlled Trial of an Intervention to Improve Coping with Intersectional Stigma and Medication Adherence Among HIV-Positive Latinx Sexual Minority Men

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Abstract

We developed and pilot-tested an eight-session community-based cognitive behavior therapy group intervention to improve coping with intersectional stigma, address medical mistrust, and improve antiretroviral treatment adherence. Seventy-six HIV-positive Latinx sexual minority men (SMM; 38 intervention, 38 wait-list control) completed surveys at baseline, and 4- and 7-months post-baseline. Adherence was electronically monitored. Intention-to-treat, repeated-measures regressions showed improved adherence in the intervention vs. control group from baseline to follow-up [electronically monitored: b (95% CI) 9.24 (− 0.55, 19.03), p = 0.06; self-reported: b (95% CI) 4.50 (0.70, 8.30), p = .02]. Intervention participants showed marginally decreased negative religious coping beliefs in response to stigma [b (95% CI) = − 0.18 (− 0.37, 0.01), p = .06], and significantly lower medical mistrust [b (95% CI) = − 0.47 (− 0.84, − 0.09), p = .02]. Our intervention holds promise for improving HIV outcomes by empowering Latinx SMM to leverage innate resilience resources when faced with stigma.

ClinicalTrials.gov ID (TRN): NCT03432819, 01/31/2018.

Resumen

Hemos desarrollado un estudio piloto para poner a prueba un programa de ocho-sesiones de terapia cognitivo-conductual basado en un grupo de comunidad para abordar el estigma interseccional, la desconfianza médica y mejorar la adherencia al tratamiento antirretroviral. Setenta y seis hombres Latinos de minorías sexuales VIH positivos (38 en el grupo de intervención, 38 en el grupo de control de lista de espera) completaron encuestas al inicio, y cuatro y siete meses después de la línea de base. La adherencia fue medida electrónicamente. Los resultados del análisis mostraron una mejor adherencia en el grupo de intervención en comparación al grupo de control desde el inicio hasta el seguimiento [monitoreado electrónicamente: b (95% IC) 9.24 (− 0.55, 19.03), p = .06; y autoreporte: b (95% IC) 4.50 (0.70, 8.30), p = .02]. Los participantes del grupo de intervención mostraron una disminución marginal en las creencias negativas de afrontamiento religioso al estigma [b (95% IC) − 0.18 (− 0.37, 0.01), p = .06], y significativamente menor desconfianza médica [b (95% IC) − 0.47 (− 0.84, − 0.09), p = .02]. Nuestra intervención es prometedora para mejorar los resultados del VIH al empoderar a hombres Latinos de minorías sexuales para tomar ventaja de los recursos de resiliencia innatos cuando se enfrentan al estigma.

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Funding

This study was supported by the National Institute of Mental Health (R34 MH113413, R01MH121256, P30MH058107).

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Authors and Affiliations

  1. RAND Corporation, 1776 Main St, Santa Monica, CA, 90401, USA

    Laura M. Bogart, David J. Klein, Terry Marsh & Denis Agniel

  2. Bienestar Human Services Inc, Los Angeles, CA, USA

    Joanna L. Barreras & Ana Gonzalez

  3. California State University Long Beach, Long Beach, CA, USA

    Joanna L. Barreras

  4. University of Massachusetts Boston, Boston, MA, USA

    David W. Pantalone

  5. The Fenway Institute, Fenway Health, Boston, MA, USA

    David W. Pantalone

Authors
  1. Laura M. Bogart
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  2. Joanna L. Barreras
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  3. Ana Gonzalez
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  4. David J. Klein
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  5. Terry Marsh
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  6. Denis Agniel
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Contributions

Bogart led the study conceptualization, funding acquisition, investigation, methodology, supervision, visualization, and writing (original draft); and supervised the data curation and formal analysis. Barreras contributed to the investigation, provided resources, and conducted project administration, supervision, validation, visualization, and writing (review & editing). Gonzalez contributed to the investigation, and conducted project administration, validation, visualization, and writing (review & editing). Klein conducted data curation, formal analysis, software/programming, and writing (original draft). Marsh contributed to project administration, validation, visualization, and writing (review & editing). Agniel contributed to the conceptualization of the data analysis and writing (reviewing and editing). Pantalone contributed to the study conceptualization, funding acquisition, investigation, methodology, and supervision, and co-led the writing (original draft).

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Correspondence to Laura M. Bogart.

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All procedures performed were in accordance with the ethical standards of the institutional review boards of the RAND Corporation and Los Angeles County Department of Public Health, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Freely-given, informed consent to participate in the study was obtained from all participants.

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Bogart, L.M., Barreras, J.L., Gonzalez, A. et al. Pilot Randomized Controlled Trial of an Intervention to Improve Coping with Intersectional Stigma and Medication Adherence Among HIV-Positive Latinx Sexual Minority Men. AIDS Behav 25, 1647–1660 (2021). https://doi.org/10.1007/s10461-020-03081-z

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