Pilot intervention for discrimination-related coping among HIV-positive Black sexual minority men.

OBJECTIVES: Discrimination is associated with worse health. Although interventions have been developed to improve coping with general stressors and chronic illness, no literature to date has reported the development and testing of an intervention specifically to address coping with discrimination. We examined the feasibility, acceptability, and preliminary effects of Still Climbin', a pilot intervention created to improve coping with discrimination experienced by HIV-positive Black sexual minority men, who face significant HIV-related disparities. METHOD: Still Climbin' was culturally tailored using community stakeholder input and formative qualitative research. Still Climbin' consists of 8 weekly group sessions and a graduation session, based on principles of cognitive behavior therapy. Sixty-four HIV-positive Black sexual minority men were recruited from community venues; 38 were randomized to the intervention and 26 to a wait-list control group. Participants completed assessments at baseline and 3- and 6-months postbaseline. Intervention participants completed postsession feedback forms. RESULTS: Repeated-measures regressions indicated significant intervention effects on improved coping in response to discrimination, including functional (problem-solving) coping [b (SE) = 0.39 (0.19), p = .04], humor [b (SE) = 0.48 (0.22), p = .03], and cognitive/emotional debriefing [b (SE) = 0.30 (0.14), p = .04], a culturally relevant form of coping that includes self-protective strategies (e.g., strategic avoidance of certain places or people). Intervention participants rated the sessions positively in response to closed- and open-ended questions. CONCLUSIONS: Still Climbin' was feasible and acceptable to participants, and showed promise for improving coping with discrimination, which ultimately can lead to better health outcomes and reduced disparities. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Coping with discrimination among HIV-positive Black men who have sex with men.

In the USA, HIV-positive Black men who have sex with men show large disparities in disease outcomes compared to other racial/ethnic and risk groups. This study examined the strategies that HIV-positive Black men who have sex with men use to cope with different types of discrimination. A total of 27 HIV-positive Black men who have sex with men participated in semi-structured interviews, which were transcribed verbatim and coded using thematic analysis by multiple raters. Major coping themes included reactive avoidance (using behaviours, cognitions and emotions to escape from discrimination), a common reaction to racism; proactive avoidance (avoiding situations in which discrimination is anticipated), manifested as selective disclosure of HIV-serostatus; external attribution for discrimination (versus self-blame), used more for sexual orientation and HIV discrimination; and social support-seeking, which most often emerged in response to racism. Active coping strategies, such as self-advocacy (countering discrimination directly or indirectly), were infrequently reported. Findings suggest a need for structural anti-discrimination interventions, in tandem with culturally congruent individual- or group-level interventions that aim to enhance men's existing adaptive coping strategies.