An mHealth Intervention to Improve Young Gay and Bisexual Men’s Sexual, Behavioral, and Mental Health in a Structurally Stigmatizing National Context (Preprint)

Abstract

Background: Young gay and bisexual men (YGBM) in Eastern European countries like Romania face high stigma and discrimination, including in healthcare. Increasing HIV transmission is a concern given inadequate prevention, travel to high-prevalence countries, and popularity of sexual networking technologies. Objective: An efficacious mobile health (mHealth) HIV-prevention intervention created in the United States was adapted and pilot-tested in Romania to reduce YGBM's HIV risk. Methods:After an intervention formative phase, 43 YGBM (M age = 23.2, SD=3.6) who reported condomless sex with a male partner and at least five days of heavy drinking in the past three months were enrolled and completed up to eight 60-minute counseling sessions based on motivational interviewing and cognitive behavioral skills training with trained counselors. Prepost intervention assessments of sexual (e.g., HIV-risk behavior), behavioral (e.g., alcohol use), and mental health (e.g., depression) outcomes were conducted to evaluate intervention impact. Results:From baseline to follow-up, participants reported significant: 1) increases in HIV-related knowledge (M=4.6 vs. M=4.8, P < 0.001) and recent HIV testing (M=2.8 vs. M=3.3, P < 0.05);2) reductions in heavy alcohol consumption (M=12.8 vs. M=6.9, P < 0.01), and 3) increases in self-efficacy of condom use (M=3.3 vs. M=4.0, P < 0.01). Participants also reported significant reductions in depression symptoms (M=1.5 vs. M=1.0, P < 0.01). Conclusions: This first mHealth HIV risk-reduction pilot intervention for YGBM in EasternEurope indicated preliminary efficacy and strong acceptability and feasibility. This mobile prevention tool lends itself to broad dissemination pending future efficacy testing, especially in contexts where stigma keeps GBM out of reach of affirmative health interventions.