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一项针对感染艾滋病毒的拉丁裔移民性少数男性应对歧视问题的认知行为疗法小组干预试点项目。

A Pilot Cognitive Behavior Therapy Group Intervention to Address Coping with Discrimination Among HIV-Positive Latino Immigrant Sexual Minority Men.

作者信息

Bogart Laura M, Galvan Frank H, Leija Jesus, MacCarthy Sarah, Klein David J, Pantalone David W

机构信息

RAND Corporation, Santa Monica, CA.

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

出版信息

Ann LGBTQ Public Popul Health. 2020;1(1):6-26. doi: 10.1891/lgbtq.2019-0003.

Abstract

Discrimination is thought to be a key driver of health disparities that affect people with multiple intersecting devalued identities, such as HIV-positive Latino sexual minority men (SMM). Ineffective coping with the stress of discrimination (e.g., rumination, substance use) may lead to worse long-term mental and physical health. Within the context of a community partnership, we developed a nine-session, community-based, cognitive behavior therapy group intervention to address coping with discrimination among HIV-positive Latino immigrant SMM. In Study 1, we assessed anticipated intervention acceptability via semi-structured interviews with 28 HIV-positive Latino SMM and ten social service providers and administrators; we used interview data to develop the manualized intervention. In Study 2, we assessed acceptability, feasibility, and preliminary effects in a pre-post, non-randomized intervention evaluation with two intervention groups of HIV-positive Latino SMM (n = 30, average age = 48.5, SD = 10.3). In semi-structured interviews, key stakeholders were enthusiastic about the proposed intervention. In the non-randomized evaluation, feasibility was evidenced by moderate levels of intervention attendance (five sessions on average); reasons for missed sessions (e.g., illness, scheduling conflict with work) were unrelated to the intervention. Linear regressions showed preliminary effects for decreased negative emotional coping responses to discrimination pre-to-post intervention (i.e., feeling less anger, sadness, powerlessness, helplessness, and shame on two subscales; b () = -0.23 (0.10), = .03; b () = -0.25 (0.11), = .03). Our intervention holds promise for reducing disparities by empowering Latino SMM to leverage innate resilience resources to improve their health in the face of discrimination.

摘要

歧视被认为是导致健康差距的关键因素,这些差距影响着具有多种交叉贬值身份的人群,比如感染艾滋病毒的拉丁裔性少数男性(SMM)。应对歧视压力的无效方式(如反复思考、使用药物)可能会导致更糟糕的长期身心健康状况。在社区伙伴关系的背景下,我们开发了一个为期九节的、基于社区的认知行为疗法小组干预项目,以帮助感染艾滋病毒的拉丁裔移民SMM应对歧视。在研究1中,我们通过对28名感染艾滋病毒的拉丁裔SMM以及10名社会服务提供者和管理人员进行半结构化访谈,评估了预期的干预可接受性;我们利用访谈数据来制定手册化干预方案。在研究2中,我们在一项前后对照、非随机的干预评估中,对两个感染艾滋病毒的拉丁裔SMM干预组(n = 30,平均年龄 = 48.5,标准差 = 10.3)评估了可接受性、可行性和初步效果。在半结构化访谈中,关键利益相关者对提议的干预措施充满热情。在非随机评估中,适度的干预参与度(平均参加五节课程)证明了可行性;错过课程的原因(如生病、与工作的日程冲突)与干预措施无关。线性回归显示,干预前后对歧视的负面情绪应对反应有所下降(即,在两个子量表上感到愤怒、悲伤、无力、无助和羞耻的程度降低;b()= -0.23(0.10),p = .03;b()= -0.25(0.11),p = .03),表明有初步效果。我们的干预措施有望通过增强拉丁裔SMM的能力,使其利用自身固有的恢复力资源来改善面对歧视时的健康状况,从而减少健康差距。

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