Siempre Seguiré: A Pilot Intervention to Improve Coping With Discrimination and Adherence Among HIV-Positive Latino MSM

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. The proposed research will
integrate adherence skills-building strategies into a recently developed intervention,
Siempre Seguiré, an 8-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. 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, HIV treatment adherence intervention
experts and key stakeholders, including a community advisory board, will help 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, a small
randomized controlled trial of 80 participants (40 intervention participants divided evenly
over 4 intervention groups vs. 40 wait-list control participants) will be conducted.
Participants will complete surveys at baseline, and 4- and 6-months post-baseline to assess
coping and HIV care processes and outcomes. Adherence will be electronically monitored, and
viral load will be collected from medical providers at baseline and at 6-month follow-up.
Intervention group sessions will take place once per week for 8 weeks. Sessions will take
place in a private room at Bienestar (a Latino-serving AIDS service organization in LAC) and
will last approximately 90 minutes. We hypothesize that the intervention will improve coping
responses to discrimination and HIV treatment adherence.

Inclusion Criteria:

- Age 18 years-old or older, HIV-positive, biologically male at birth and continue to
identify as male, identify as Latino, report having sex with men in the past 12
months, and prescribed ART.

Exclusion Criteria:

- Being unwilling or unable to provide informed consent; having mental health problems
that require immediate treatment (e.g., psychotic symptoms) or a diagnosed mental
disorder that would limit ability to participate (e.g., dementia); and cognitive
impairments that result in limited ability to provide informed consent.