Increasing Engagement and Improving HIV Outcomes Via HealthMPowerment

Multiple stigmas related to sexuality, race, and HIV infection negatively impact HIV testing,
engagement in HIV care, and consistent viral suppression (VS) among young Black or Latino men
who have sex with men and transgender women (YBLMT). At present, few interventions have
addressed the effects of intersectional stigma among HIV-infected and uninfected populations.
This study tests whether an online intervention tailored for intersectional stigma
amelioration can elicit online social support, promote intervention engagement, and mitigate
the impact of multiple stigmas on HIV-related outcomes. This study will recruit and enroll
1,050 young (ages 15-29), racially and ethnically diverse men who have sex with men and
transgender women affected by HIV across the United States. Using a HIV-status stratified
randomized trial design, participants will be assigned into one of three conditions
(information-only control, a researcher-driven social network intervention, or a peer-driven
social network intervention). Behavioral assessments will occur at baseline, 3, 6, 9 and 12
months; biomarkers (viral load) are scheduled for baseline, 6 and 12 months. The primary
outcome is stratified by HIV status and defined as successful engagement in care (consistent
VS for HIV-positive participants and routine testing for HIV-negative participants). The
specific aims are: 1) Test whether an online intervention that promotes user-generated
content and engagement to address intersectional stigma is associated with improvements in
the HIV prevention and care continuum (HIV testing, antiretroviral adherence, VS) as compared
to an information-only control arm; 2) Explore whether user engagement, as measured by
quantitative and qualitative paradata, mediates the intervention's stigma- and HIV
care-related outcomes; and, 3) Examine how changes in intersectional stigma and improvements
across the HIV care continuum vary between the researcher-driven vs. peer-driven social
network intervention conditions. The research study is innovative given its focus on
intersectional stigma as a key target of intervention, and its ability to assess how
different kinds of online social network structures influence participants' engagement over
time, reduce experiences of intersectional stigma, and improve successful engagement in care.
This research addresses a critical need to reduce the effects of multiple stigmas in a
priority population using an intervention delivered through a highly appealing,
widely-utilized technology. If effective, this form of stigma amelioration via online support
can be broadly disseminated to reduce HIV transmission and improve care among YBLMT.

Inclusion Criteria:

- Ages 15-29 (inclusive);

- Identify as Black/African American and/or Latino/Hispanic;

- Be U.S. residents (verified by zip code);

- Report at least one episode of condomless anal sex act with a man in prior 6 months;

- Assigned male sex at birth;

- Currently identifies as male or as woman

- Have access to internet

- Reports owning or having regular access to a smartphone device or laptop/tablet
through which to log onto the study site.

Exclusion Criteria:

- Assigned female sex at birth

- Aged 14 years or younger or 30 years or older at time of screening

- Does not speak or read English or Spanish

- Did not have consensual anal sex with a male partner in the prior 6 months

- Does not reside in the United States

- Currently incarcerated

- Planning to move out of the United States in next 12 months