Siempre Seguire: A Pilot Intervention to Improve Coping With Discrimination and Adherence Among HIV-Positive Latino MSM

Abstract: HIV-related disparities in diagnosis and disease outcomes persist among Latinos, and Latinos living with HIV show a lower percentage of viral suppression compared to the general HIV-positive population. A growing body of work suggests that stigma and discrimination contribute to health disparities, especially among people living with HIV, who may experience discrimination due to multiple stigmatized identities related to HIV- serostatus, race/ethnicity, and sexual orientation. Internalized stigma and discrimination may lead to health- related disparities by increasing detrimental physiological stress responses, resulting in maladaptive coping and poor health behaviors, including non-adherence to treatment. Moreover, the chronic stress of discrimination may weaken immune function, leading to worse HIV outcomes, including increased HIV viral load. In the proposed research, we will integrate adherence skills-building strategies into a recently developed intervention, Siempre Seguiré, a 7-session group cognitive behavioral therapy (CBT) intervention for HIV- positive Latino men who have sex with men (LMSM) that aims to improve adaptive coping responses to discrimination. In a small pilot of 30 participants, the intervention was associated with improved coping at follow-up as compared to baseline. However, this pilot did not include a control group, did not address or examine HIV-related behaviors and outcomes such as adherence, retention in care, and viral load suppression, and had a very low sample size. Thus, in the proposed research, we will conduct a larger pilot study in which preliminary effects on HIV outcomes can be assessed. The specific aims are: (1) To modify and refine Siempre Seguiré, a newly developed culturally congruent CBT group intervention for HIV-positive LMSM, to include strategies for antiretroviral treatment adherence and retention in HIV care; and (2) To conduct a small randomized pilot of Siempre Seguiré to examine feasibility and acceptability, as well as to explore preliminary effects on: (a) coping responses to discrimination; and (b) antiretroviral treatment adherence, viral load suppression, and HIV care retention, among LMSM living with HIV. In Phase 1, we will work with HIV treatment adherence intervention experts and key stakeholders, including a community advisory board, to refine our pilot intervention as needed and update our manual to integrate information and skills building regarding HIV treatment adherence and retention in care. In Phase 2, we will conduct a small randomized controlled trial of 80 participants (40 intervention participants divided evenly over 4 intervention groups vs. 40 wait-list control participants). To our knowledge, our study will be the first to test an intervention that addresses coping with discrimination from multiple identities. Our proposed research is consistent with the Institute of Medicine report, The Health of Lesbian, Gay, Bisexual, and Transgender People, which recommends developing interventions to address racial disparities and mental health effects of discrimination among sexual minorities.

Project Number: 1R34MH113413-01A1