PROJECT SUMMARY Stigma directed towards gay and bisexual men (GBM) are known to create the condition of minority stress that affects their mental and sexual health in a syndemic manner, resulting in anxiety, depression, suicide, substance and alcohol abuse and risky sexual practices. Resilience is recognized as an important protective factor against minority stress. A recent U.S.-based study demonstrated that ESTEEM, a cognitive behavioral therapy-based intervention aimed at promoting personal agency and resilience is efficacious in improving mental and sexual health of young GBM. However, there is an urgent need to adapt existing minority stress interventions for scalability to the local context of GBM individuals living in hostile environment with limited resources (especially in non-Western countries). Despite consensual sex between men is legal in Viet Nam, GBM face many challenges in their daily lives. Meanwhile, little quantitative data are available regarding the mental health status of GBM, including the role of stigma and other factors in causing mental and sexual health problems in this population. In this regard, we propose to develop and pilot test a community-based, peer-driven minority stress as well as HIV-stigma reduction program based on ESTEEM in small groups of self-identified GBM in Ho Chi Minh City (HCMC), Viet Nam. The intervention (“Vina-STEAM”-- Skills to Empower Affirmative Men) is aimed to build resilience to minority stress and HIV-related stigma in order to promote positive sexual health. Specifically, we hypothesize that the intervention will result in more regular HIV testing and engagement of PrEP prevention efforts due to the reduction in negative behavioral (i.e., alcohol abuse; illicit drug use; unprotected anal sex) and psychological (i.e., anxiety and depression) stressors. Our mixed-method study will involve: (1) preparation stage, (2) formative stage, where qualitative data from Vietnamese GBM and key informants will inform adaptation of the ESTEEM package; (3) feasibility test, where the adapted intervention will be pilot-tested in a small sample (4 small groups, N = 24) of GBM and further adjusted based on the pilot-test results; (4) small-scale efficacy test of the adjusted intervention using a randomized wait-list controlled design in a cohort of 120 GBM, where they will be randomly assigned to either an immediate intervention or a waitlist controlled arm in groups of 10 (i.e. 12 groups). The proposed intervention will be one of the first to promote resilience to minority stress among GBM in a developing country (i.e., Viet Nam), where there is persuasive homophobic stigma. Also, it is one of the first to test a peer-led intervention addressing the impact of minority stress on mental and sexual health of GBM in such setting. If successful, this intervention can be expanded for a full R01 efficacy trial and adapted for use in other highly marginalized GBM populations, e.g. those residing in rural areas of the United States as well as GBM in other developing countries.

PROJECT NARRATIVE ESTEEM -- administered by licensed clinical psychologists -- is a psychosocial intervention that has shown promising results in improving mental and sexual health of young gay and bisexual men (GBM) in New York, U.S.A. We propose to adapt ESTEEM as a community-based, peer-driven pilot intervention to mitigate HIV- related stigma (e.g., including stigma using pre-exposure of prophylaxis or PrEP) among HIV-negative GBM in Ho Chi Minh City, Viet Nam., where the delivery format is more congruent with cultural practices. If successful, this intervention can be applied to other settings where resources are limited.