PROJECT SUMMARY
HIV-related disparities in diagnosis and disease outcomes persist among Latinos, and Latinos living with HIV
show a lower percentage of viral suppression compared to the general HIV-positive population. A growing
body of work suggests that stigma and discrimination contribute to health disparities, especially among people
living with HIV, who may experience discrimination due to multiple stigmatized identities related to HIV-
serostatus, race/ethnicity, and sexual orientation. Internalized stigma and discrimination may lead to health-
related disparities by increasing detrimental physiological stress responses, resulting in maladaptive coping
and poor health behaviors, including non-adherence to treatment. Moreover, the chronic stress of
discrimination may weaken immune function, leading to worse HIV outcomes, including increased HIV viral
load. In the proposed research, we will integrate adherence skills-building strategies into a recently developed
intervention, Siempre Seguiré, a 7-session group cognitive behavioral therapy (CBT) intervention for HIV-
positive Latino men who have sex with men (LMSM) that aims to improve adaptive coping responses to
discrimination. In a small pilot of 30 participants, the intervention was associated with improved coping at
follow-up as compared to baseline. However, this pilot did not include a control group, did not address or
examine HIV-related behaviors and outcomes such as adherence, retention in care, and viral load
suppression, and had a very low sample size. Thus, in the proposed research, we will conduct a larger pilot
study in which preliminary effects on HIV outcomes can be assessed. The specific aims are: (1) To modify and
refine Siempre Seguiré, a newly developed culturally congruent CBT group intervention for HIV-positive
LMSM, to include strategies for antiretroviral treatment adherence and retention in HIV care; and (2) To
conduct a small randomized pilot of Siempre Seguiré to examine feasibility and acceptability, as well as to
explore preliminary effects on: (a) coping responses to discrimination; and (b) antiretroviral treatment
adherence, viral load suppression, and HIV care retention, among LMSM living with HIV. In Phase 1, we will
work with HIV treatment adherence intervention experts and key stakeholders, including a community advisory
board, to refine our pilot intervention as needed and update our manual to integrate information and skills
building regarding HIV treatment adherence and retention in care. In Phase 2, we will conduct a small
randomized controlled trial of 80 participants (40 intervention participants divided evenly over 4 intervention
groups vs. 40 wait-list control participants). To our knowledge, our study will be the first to test an intervention
that addresses coping with discrimination from multiple identities. Our proposed research is consistent with the
Institute of Medicine report, The Health of Lesbian, Gay, Bisexual, and Transgender People, which
recommends developing interventions to address racial disparities and mental health effects of discrimination
among sexual minorities.
