NIH Reporter #1R01TW013191-01

Healthy Choices to Reduce Stigma and Improve Self-Management of Alcohol and HIV among Young Adults

This award funds the adaptation and pilot testing of the Healthy Choices behavioral intervention to reduce stigma and improve self-management of alcohol use and HIV among young adults, specifically targeting Spanish-speaking youth with HIV in the Dominican Republic, with potential application in the U.S.

Description

Healthy Choices is a four-session behavior change communication intervention tailored for emerging adults to address self-management of health behaviors and HIV, with evidence of positive effects on stigma and depression. Built on Motivational Enhancement Therapy, it integrates Motivational Interviewing with brief cognitive-behavioral strategies. The intervention can be delivered in community settings by trained community health workers, resulting in reductions in alcohol use, HIV stigma, viral loads, and depression over follow-up compared to standard care. In the Dominican Republic, stigmas harm young people with HIV (YPWH). The country accounts for over 95% of Caribbean HIV infections and has a culture that perpetuates stigmatizing attitudes. There are no Spanish-language interventions that address mental health, viral suppression, and stigma for young adults in this developmental period. The project aims to adapt Healthy Choices for Spanish, co-create implementation strategies with community input, and pilot test the intervention for feasibility, acceptability, and potential effectiveness. The study will use the Exploration, Preparation, Implementation, Sustainment (EPIS) model, engaging community-based organizations and clinics in the Dominican Republic. The project proposes three aims: 1. Elucidate barriers and strategies for the intervention. 2. Adapt and culturally translate the intervention. 3. Pilot test the adapted intervention. If successful, the project will provide preliminary data for a full-scale effectiveness and implementation randomized controlled trial targeting underserved Spanish-speaking YPWH in the Dominican Republic, with potential relevance to similar groups in the United States.

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