PROJECT SUMMARY
Black men, especially Black sexual minority men (SMM), are negatively affected by health and healthcare
disparities: They show worse outcomes for preventable conditions and preventable complications from chronic
conditions, and are less likely to engage with healthcare than are White men and women. Moreover, Black
SMM display strikingly high rates of HIV and other sexually transmitted infections. Based on evidence-based
theory that discrimination contributes meaningfully to disparities, we propose to conduct a randomized
controlled trial (RCT) of an 8-session culturally congruent cognitive behavior therapy group intervention, Still
Climbin’, which aims to increase effective coping responses to discrimination (from intersectional race and
sexual minority identities) and reduce medical mistrust among Black SMM, with the goal of improving
healthcare engagement and receipt of evidence-based preventive care. Still Climbin’ has a strong scientific
basis in our prior pilot work, which found that the proposed intervention is acceptable to key stakeholders,
feasible to conduct, and associated with improved effective coping. The specific aims are: (1) To conduct a
randomized controlled trial to test the effects of Still Climbin', a culturally congruent cognitive behavior therapy
group intervention, on healthcare engagement (e.g., at least one ambulatory visit in the past 6 months) and
receipt of evidence-based preventive care (e.g., chronic disease screenings) among Black sexually minority
men; (2) To examine mechanisms of the intervention’s effects on improved healthcare engagement and receipt
of evidence-based preventive care, including more effective coping skills and reduced medical mistrust; and (3)
To examine potential moderators of the intervention’s effects (e.g., age, HIV-serostatus and other health
conditions). In the context of established community-academic partnerships, we will conduct the RCT with 300
Black SMM, randomizing 150 to the intervention group and 150 to a wait-list control group. Participants will
complete surveys at baseline and 3-, 6-, and 12-months post-baseline to assess the primary outcomes, and
potential mediators, covariates, and moderators. Healthcare engagement, receipt of evidence-based care, and
health conditions will be verified with medical records. With the exception of our own work, we are not aware of
any interventions that address coping with discrimination from intersectional identities in order to improve
health outcomes among Black SMM. Our research is consistent with Healthy People 2020, which recommends
developing interventions to address effects of discrimination among sexual minority individuals. Although
structural-level interventions are critical for reducing societal discrimination as a long-term strategy, individual-
level interventions—such as Still Climbin’—are needed in tandem to reduce discrimination’s immediate health
effects.
