PROJECT SUMMARY/ABSTRACT
In Ghana, MSM bear a high HIV burden, yet less than 4% of HIV-positive MSM are on antiretroviral therapy—a
disparity found throughout Africa. Social stressors, such as sexuality- and gender-based stigma, criminalization,
and violence, have been linked to both poor mental health and HIV outcomes and may be barriers to optimal
HIV service engagement among African MSM. The goal of this K01 application is to apply intersectionality and
minority stress theory to examine the impact of intersectional social stressors on mental health and HIV treatment
and care of HIV-positive men who have sex with men in Ghana and to adapt and theater test a community-
engaged intersectional stigma intervention to improve mental health and HIV treatment outcomes. To achieve
this goal, the training aims of this proposal are: 1) to develop content expertise in intersectional social stressors
and minority stress theory and the intersection of these theories in understanding mental health; 2) to develop
methodological expertise in intersectional social stressor measurement, including how latent constructs are
operationalized and measured; 3) to gain methodological expertise in advanced statistical methods (structural
equation modeling, mediation, and dominance analysis) towards understanding pathways that can be interrupted
to improve health; and 4) to obtain knowledge & skills in community engaged, evidence-based intersectional
intervention design in order to conduct impactful interventions for the populations most in need. The training aims
will be achieved through a research plan that proposes to integrate intersectionality and minority stress theory
and operationalize measures to study the following specific aims: 1) to explore the intersectional social stressor,
mental health, and HIV treatment experiences of HIV-positive MSM in order to adapt, conceptually define, and
operationalize constructs in the integrated intersectional minority stress model for use in Ghana; 2) to identify
intervenable factors in the relationship between intersectional social stressors, mental health, protective factors,
and HIV treatment outcomes (linkage and retention in treatment and care); and 3) to adapt and theater test an
integrated intersectional mental health and HIV treatment intervention to help MSM cope with the impact of
intersectional social stressors on HIV treatment outcomes.