A pilot test of a treatment to address intersectional stigma, mental health, and HIV risk among gay and bisexual men of color.

Abstract

We tested the feasibility and acceptability of a group therapy treatment that addresses the intersecting stigma-related stressors theorized to drive elevated mental health risk, sexual health risk, and their co-occurrence among Black and Latino gay, bisexual, and other men who have sex with men (GBM). First, we modified an existing 10-week, one-on-one, cognitive–behavioral treatment addressing co-occurring health risks among GBM to develop a group-based, intersectionally informed treatment for GBM of color. Then, an open pilot was conducted (n = 21, across two cohorts) with young Black and Latino GBM. An evaluation of feasibility metrics (e.g., eligibility–enrollment ratio, session attendance, rate of retention) supported overall treatment feasibility. Qualitative data suggest high acceptability of the treatment length, format, and content—and revealed a powerful theme: The treatment and group composition led participants to feel less alone as GBM of color. To further evaluate acceptability, baseline and 3-month posttreatment assessments and exit interviews were used to examine the treatment’s impact on stigma coping, mental health, and sexual health. Expected changes were found for: (a) stigma coping, as demonstrated by decreases in perceived sexual minority stress, racial minority stress, and intersectional stress; (b) mental health, including depression, anxiety, stress, and suicidality, but not alcohol use; and (c) sexual health, including condom use efficacy, sexual compulsivity, and preexposure prophylaxis uptake; with partial support for decreased in human immunodeficiency virus; HIV-transmission risk acts. This study lays the groundwork for a group treatment to address intersectional stigma, mental health, and HIV risk among young Black and Latino GBM in the U.S.

LGBTQI cancer patients’ quality of life and distress: A comparison by gender, sexuality, age, cancer type and geographical remoteness

“…In combination, this suggests that psychological outcomes may be worse for LGBTQI people with cancer than has previously been estimated ( 106 ) as there has been a dearth of research that included TGD, AYA and intersex people with cancer, as well as those who identified as bisexual or queer ( 1 ). These differences in health outcomes in LGBTQI sub-groups are reflected in differences in the psycho-social concomitants of distress and QOL, which can be conceptualized as intersecting stigma-related stressors ( 107 ). TGD, intersex, AYA, queer and bisexual subgroups reported higher levels of a number of these stressors, including discomfort with being LGBTQI, discrimination in life and in cancer care, lower outness, greater impact of cancer on LGBTQI identity and gender identity, and lower social support, likely contributing to their higher distress and poorer QOL.…”

“…Minority stress theory ( 61 ) explains the link between stigma-related distal stressors in a person’s environment, such as LGBTQI discrimination, social rejection, homophobia and transphobia, and health. Research drawing on this framework suggests that living in a hostile, discriminatory context can elicit internal, health-eroding proximal stress processes related to individuals’ minority status, including anxious expectations of rejection, identity concealment, and internalized stigma ( 107 , 146 ). This is reflected in the chronic stress experienced by LGBTQI people, as the result of stigmatization and discrimination within heterosexist and transphobic societies ( 147 , 148 ).…”

Training in LGBTQ-affirmative cognitive behavioral therapy: A randomized controlled trial across LGBTQ community centers.

“…This wait-list-controlled trial establishes the preliminary efficacy of training mental health providers to deliver LGBTQ-affirmative CBT, an intervention with increasing empirical evidence for improving LGBTQ people's mental health (Jackson et al, 2022;Pachankis et al, 2020;Pachankis, Harkness, et al, 2022). In this study, mental health providers working at LGBTQ community centers across the U.S., Canada, and Uganda were trained to deliver this treatment that applies CBT tenets to addressing the cognitive, affective, and behavioral targets through which minority stress undermines LGBTQ people's mental health (Pachankis, Soulliard, et al, 2022).…”

“…LGBTQ-affirmative adaptations were generated through deep consultation with LGBTQ community members and clinical experts (Pachankis, 2014;Pachankis, Soulliard, et al, 2022;Scheer et al, in press). The treatment has been effectively delivered in individual and group formats and implemented in community-based clinics (e.g., Jackson et al, 2022;Pan et al, 2021), supporting its promise for broader implementation beyond the controlled trials in which it was originally developed and tested. Broader implementation of evidence-based practice can be achieved by training providers in such practice (Lehane et al, 2019) and training providers to deliver LGBTQ-affirmative evidence-based care, specifically, represents a promising way to reduce the barriers to LGBTQ-affirmative mental health care described above.…”

“…These LGBTQ-affirmative adaptations were generated through deep consultation with LGBTQ community members and clinical experts (Pachankis, 2014; Pachankis, Soulliard, et al, 2022; Scheer et al, in press). The treatment has been effectively delivered in individual and group formats and implemented in community-based clinics (e.g., Jackson et al, 2022; Pan et al, 2021), supporting its promise for broader implementation beyond the controlled trials in which it was originally developed and tested.…”