PROJECT SUMMARY/ABSTRACT In Ghana, MSM bear a high HIV burden, yet less than 4% of HIV-positive MSM are on antiretroviral therapy—a disparity found throughout Africa. Social stressors, such as sexuality- and gender-based stigma, criminalization, and violence, have been linked to both poor mental health and HIV outcomes and may be barriers to optimal HIV service engagement among African MSM. The goal of this K01 application is to apply intersectionality and minority stress theory to examine the impact of intersectional social stressors on mental health and HIV treatment and care of HIV-positive men who have sex with men in Ghana and to adapt and theater test a community- engaged intersectional stigma intervention to improve mental health and HIV treatment outcomes. To achieve this goal, the training aims of this proposal are: 1) to develop content expertise in intersectional social stressors and minority stress theory and the intersection of these theories in understanding mental health; 2) to develop methodological expertise in intersectional social stressor measurement, including how latent constructs are operationalized and measured; 3) to gain methodological expertise in advanced statistical methods (structural equation modeling, mediation, and dominance analysis) towards understanding pathways that can be interrupted to improve health; and 4) to obtain knowledge & skills in community engaged, evidence-based intersectional intervention design in order to conduct impactful interventions for the populations most in need. The training aims will be achieved through a research plan that proposes to integrate intersectionality and minority stress theory and operationalize measures to study the following specific aims: 1) to explore the intersectional social stressor, mental health, and HIV treatment experiences of HIV-positive MSM in order to adapt, conceptually define, and operationalize constructs in the integrated intersectional minority stress model for use in Ghana; 2) to identify intervenable factors in the relationship between intersectional social stressors, mental health, protective factors, and HIV treatment outcomes (linkage and retention in treatment and care); and 3) to adapt and theater test an integrated intersectional mental health and HIV treatment intervention to help MSM cope with the impact of intersectional social stressors on HIV treatment outcomes.

PROJECT NARRATIVE In Ghana, where sexual minorities are criminalized, men who have sex with men bear the highest HIV burden, with a prevalence of 18.0%, yet, only 3.7% of HIV-positive MSM are on antiretroviral therapy—a gap found throughout Africa. Theory-based inquiry into the multilevel HIV treatment needs of African MSM living with HIV can inform scalable, efficacious interventions and adaptation with input from community. This study proposes to integrate intersectionality and minority stress theory and operationalize measures to examine how intersectional social stressors affect mental health and HIV treatment outcomes among Ghanaian MSM living with HIV and to develop an intervention to mitigate factors on this pathway to improve health.