The Influence of Internalized Stigma on the Efficacy of an HIV Prevention and Relationship Education Program for Young Male Couples

Feinstein, Brian A.; Bettin, Emily; Swann, Gregory; Macapagal, Kathryn; Whitton, Sarah W.; Newcomb, Michael E.

doi:10.1007/s10461-018-2093-6

Cited by 15 publications

(12 citation statements)

References 46 publications

(71 reference statements)

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“…Even fewer interventions examined stigma as a mechanism of intervention effects as predicted by minority stress theory [30,53]. Few studies tested stigma as a moderator of intervention efficacy [14,23,37], which would inform how individual exposure to stigma alters program efficacy.…”

Section: Discussionmentioning

confidence: 99%

“…Stigma was operationalized across internalized (64.8%, n = 24), anticipated (32.4%, n = 12), enacted (67.8%, n = 21), and structural levels (8.1%, n = 3). For internalized stigma, interventions most frequently reported addressing internalized homophobia/homonegativity/binegativity (27.02%, n = 10) [16][17][18][19][20][21][22][23][24][25][26][27]. Internalized HIV stigma was the most commonly addressed non-SGM stigma (16.2%, TBM n = 6) [28][29][30][31][32][33].…”

Section: Stigma In Sexual and Gender Minority Interventionsmentioning

confidence: 99%

“…Experiences of internalized HIV stigma did not mediate intervention effects in one intervention [30], whereas reductions in condomless anal intercourse in the Socially Optimized Learning Virtual Environments (SOLVE) intervention were fully mediated by reductions in experiences of sexual shame [53]. Discrimination coping [14] and internalized stigma [23,37] moderated intervention effects.…”

Section: Mediation and Moderationmentioning

confidence: 99%

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A systematic review of stigma in sexual and gender minority health interventions

Layland

Carter

Perry

et al. 2020

Translational Behavioral Medicine

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Stigma against sexual and gender minorities is a major driver of health disparities. Psychological and behavioral interventions that do not address the stigma experienced by sexual and gender minorities may be less efficacious. We conducted a systematic review of existing psychological and behavioral health interventions for sexual and gender minorities to investigate how interventions target sexual and gender minority stigma and consider how stigma could affect intervention efficacy. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed. Eligible studies were peer reviewed and published in English between January 2003 and July 2019 and reported empirical results of behavioral or psychological interventions implemented among sexual and gender minorities. All interventions addressed stigma. We identified 37 eligible interventions. Most interventions targeted sexual minority men. Interventions were frequently developed or adapted for implementation among sexual and gender minorities and addressed multiple levels and types of stigma. Interventions most frequently targeted proximal stressors, including internalized and anticipated stigma. HIV and mental health were the most commonly targeted health outcomes. A limited number of studies investigated the moderating or mediating effects of stigma on intervention efficacy. The application of an intersectional framework was frequently absent and rarely amounted to addressing sources of stigma beyond sexual and gender minority identities. A growing number of interventions address sexual and gender minority stigma in an effort to prevent deleterious health effects. Future research is needed to assess whether stigma modifies the effectiveness of existing psychological and behavioral interventions among sexual and gender minorities. Further, the application of intersectional frameworks is needed to more comprehensively intervene on multiple, intersecting sources of stigma faced by the diverse sexual and gender minority community.

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Section: Discussionmentioning

confidence: 99%

Section: Stigma In Sexual and Gender Minority Interventionsmentioning

confidence: 99%

Section: Mediation and Moderationmentioning

confidence: 99%

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A systematic review of stigma in sexual and gender minority health interventions

Layland

Carter

Perry

et al. 2020

Translational Behavioral Medicine

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“…Specifically, we examined whether sexual minorities who are exposed to LGBTQ-related discrimination and victimization would benefit most from these interventions. Based on past tests of intervention moderation with this population (e.g., Feinstein et al, 2018; Millar, Wang, & Pachankis, 2016), we reasoned that those who experienced more contextual minority stressors would have the most to gain from these interventions. Knowing whether and under what contexts these brief online writing interventions work can provide the treatment community with needed guidance for reaching sexual minority young adults, who, despite being at risk of mental health problems and health-risk behaviors, often exist out of reach of identity-affirming evidence-based treatments because of structural barriers.…”

Section: The Present Studymentioning

confidence: 99%

Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context.

Pachankis

Williams

Behari

et al. 2020

Journal of Consulting and Clinical Psychology

113

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College of the Holy CrossObjective: To identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions-expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee. Method: In consultation with sexual minority young adults (n ϭ 10) and stakeholders (n ϭ 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (M age ϭ 23.68, SD ϭ 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up. Results: Compared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d ϭ 0.48) and general psychological distress (d ϭ 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d ϭ 0.62) and drug abuse (d ϭ 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control. Conclusion: Brief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. What is the public health significance of this article?This study responds to the pressing need for efficacious interventions to improve sexual minority young adult mental and behavioral health. We find evidence that two brief online writing interven-

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“… 26 , 43 , 51 , 52 , 57 , 58 , 64 , 71 , 76 , 78 , 79 Most studies were implemented after 2000. 20 – 26 , 34 – 37 , 39 – 79 , 81 …”

Section: Resultsmentioning

confidence: 99%

Evidence and implication of interventions across various socioecological levels to address HIV testing uptake among men who have sex with men in the United States: A systematic review

2022

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Objectives: Strengthening HIV testing uptake is critical to curtail the HIV epidemics among men who have sex with men in the United States. Despite the implementation of various interventions to promote HIV testing among men who have sex with men, few aggregated evidence is presented to reflect the “lessons learned” and inform future directions. The objective of this systematic review is to comprehensively summarize published studies that described, tested, and evaluated outcomes (e.g. efficacy, effectiveness, acceptability, feasibility and/or qualitative opinions) associated with an HIV testing intervention and identify gaps as well as opportunities to inform the design and implementation of future interventions to enhance HIV testing uptake among men who have sex with men in the United States. Methods: We followed the PRISMA guidelines and conducted a systematic review of articles (published by 23 July 2021) by searching multiple databases (PubMed, MEDLINE, Web of Science and PsycINFO). Results: Among the total number of 3505 articles found through multiple databases, 56 papers were included into the review. Interventional modules that demonstrated acceptability, feasibility and efficacy to improve HIV testing uptake among men who have sex with men include: HIV self-testing, interpersonal-level (e.g. peer-led, couple-based) interventions, personalized interventions and technology-based interventions (e.g. mHealth). Aggregated evidence also reflects the lack of individualized interventions that simultaneously address time-varying needs across multiple socioecological levels (e.g. individual, interpersonal, community, structural and societal). Conclusion: Development of interventions to improve HIV testing rates and frequency of men who have sex with men has proliferated in recent years. Our review presents important implications in sustaining and improving interventions to address HIV testing uptake among men who have sex with men in the United States.

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The Influence of Internalized Stigma on the Efficacy of an HIV Prevention and Relationship Education Program for Young Male Couples

Cited by 15 publications

References 46 publications

A systematic review of stigma in sexual and gender minority health interventions

A systematic review of stigma in sexual and gender minority health interventions

Brief online interventions for LGBTQ young adult mental and behavioral health: A randomized controlled trial in a high-stigma, low-resource context.

Evidence and implication of interventions across various socioecological levels to address HIV testing uptake among men who have sex with men in the United States: A systematic review

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