Young Black gay, bisexual and other men who have sex with men (YB-GBMSM) experience high HIV prevalence and incidence, but suboptimal rates of engagement across the HIV Continuum of Care (HIV-CoC). Treatable mental health (MH) conditions such as depressive disorders, anxiety disorders, trauma- and stressor-related disorders, and substance use are major determinants of HIV-CoC outcomes; however, MH services utilization rates are low in this population. There is a need for culturally -tailored interventions to improve MH service utilization among YB-GBMSM, in order to improve both HIV-CoC and MH outcomes. Our long-term goal is to identify novel approaches to promoting and delivering MH services for YB-GBMSM living with HIV. The objective of this R21 application is to develop an understanding of influences on MH service utilization among YB-GBMSM living with HIV. The rationale for the project is that the influences on HIV and MH care are often overlapping and/or synergistic, and that cultural considerations are critically important to understanding these factors. Our study will be based in Atlanta, Georgia ? an HIV epicenter. The theoretical foundation for the study is a preliminary conceptual model based on Andersen?s Behavioral Model of Health Service Use, which we have culturally adapted using theories and frameworks with particular relevance for YB- GBMSM (minority stress, intersectionality, and resilience). This study will pursue three specific aims: (1) to qualitatively explore conceptualizations of MH service utilization among YB-GBMSM living with HIV, including investigation of associated sociocultural, demographic and clinical influences; (2) to quantitatively examine relationships between constructs in our conceptual model, MH service utilization, and HIV-CoC outcomes; and (3) To develop program objectives and methods for a culturally-tailored intervention designed to enhance acceptability and uptake of MH services, and improve HIV-CoC outcomes, among YB-GBMSM living with HIV. For the first aim, we will conduct N=40 qualitative interviews to understand conceptualizations of MH and MH services, and to refine a conceptual model based on Andersen?s Behavioral Model. For the second aim, we will test the relationships in our model using quantitative data from N=200 cross-sectional surveys that we will conduct with YB-GBMSM living with HIV. For the third aim, we will synthesize the findings from Aims 1 and 2 to begin development of an intervention to enhance MH service utilization among YB-GBMSM living with HIV, using the Intervention Mapping approach. The proposed research is highly significant because of its potential to inform effective strategies for improving HIV-CoC outcomes among YB-GBMSM, with important implications for both individual and public health outcomes.

Public Health Relevance

The proposed project seeks to understand influences on the use of mental health services by young Black gay, bisexual and other men who have sex with men (YB-GBMSM) who are living with HIV. This project is relevant to public health because YB-GBMSM are disproportionately impacted by HIV and mental health conditions, but often do not seek mental health care. Our proposal is responsive to the NIH Office of AIDS Research mandate to conduct research to reduce disparities in health outcomes for people living with HIV.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Exploratory/Developmental Grants (R21)
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HIV/AIDS Intra- and Inter-personal Determinants and Behavioral Interventions Study Section (HIBI)
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Allison, Susannah
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Emory University
Public Health & Prev Medicine
Schools of Public Health
United States
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