Intersectional minority stress, mental health, and HIV treatment and care among MSM living with HIV in Ghana

PROJECT SUMMARY/ABSTRACT In Ghana, men whose sexualities are criminalized bear a high HIV burden, yet less than 4% of these men living with HIV are on antiretroviral therapy—a gap found throughout Africa. Social stressors, such as 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 this population in Africa. The goal of this K01 application is to apply intersectionality and stress theory (MST) to examine the impact of intersectional social stressors on mental health and HIV treatment and care of HIV-positive men whose sexualities are criminalized 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 intersectionality and MST 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 MST 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 men whose sexualities are criminalized in order to adapt, conceptually define, and operationalize constructs in the integrated intersectional social stressor 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 HIV-positive men whose sexualities are criminalized cope with the impact of intersectional social stressors on HIV outcomes.