a unified intervention for young gay and bisexual men's minority stress, mental health, and hiv risk

Conditions: HIV; Acquired Immunodeficiency Syndrome

Summary: the intent of the proposed randomized controlled trial is to test the efficacy of a principle-based, transdiagnostic cognitive behavioral therapy (cbt) intervention that addresses the pathways through which minority stress compromises young gay and bisexual men's (ygbm) co-occurring mental (e.g., depression), behavioral (e.g., substance use), and sexual (e.g., condomless anal sex) health problems.

esteem (effective skills to empower effective men) is a 10-session skills-building intervention designed to reduce young gay and bisexual men's (ygbm) co-occurring health risks by reducing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs ygbm's health. esteem is based on the unified protocol, a cognitive-behavioral therapy (cbt) approach with efficacy across mental health and risk behaviors. in an initial study to create esteem , the unified protocol was adapted by conducting interviews with 21 ygbm-expert mental health providers and 20 depressed, anxious ygbm at high risk for hiv infection. in a preliminary trial (nct02448186), esteem significantly reduced ygbm's spectrum of interrelated health threats, making it the first evidence-based intervention to simultaneously improve mental health, substance use, and sexual health outcomes among ygbm. important questions remain in order to validate the efficacy and potential cost-effectiveness of esteem. accordingly, we propose a 3-arm rct that would examine (1) whether esteem (arm 1) demonstrates significant improvements compared to existing lgbt-affirmative community mental health treatment (cmht; arm 2) or standard hiv/std voluntary counseling and testing (vct; arm 3) for high-risk depressed and anxious ygbm and (2) whether it improves outcomes through reducing hypothesized cognitive, affective, and behavioral minority stress processes.

Eligibility criteria:
inclusion criteria: * self-identification as a gay, bisexual or queer man; * hiv-negative status confirmed through in-office testing; * diagnosis of any dsm-5 depressive, anxiety, or trauma-/stress-related disorder; * risk of hiv transmission through sexual activity (≥ 1 act of past-90-day-condomless anal sex involving a flesh penis with a partner with an unknown hiv status or an hiv-positive status, unless with an hiv-positive primary or main partner with known undetectable viral load or an hiv-negative primary or main partner who is known to be adherent to prep); * not themselves currently adherent to prep (defined as taking prep on ≥ 4 days/week); * nyc or miami residential stability and planned availability for 12 months; * english-language proficiency; and (9) provision of informed consent. exclusion criteria: * current active suicidality or homicidality (but not passive suicidality); * evidence of active untreated mania, psychosis, or gross cognitive impairment; * current enrollment in another intervention study; * currently receiving 1 or more mental health treatment sessions/month or 8 or more cbt sessions within the past year; * hiv-positive status (confirmed through in-office testing).

Keywords: minority stress