# Developing efficient intervention technologies to reduce stigma-related stress, mental health problems, and HIV risk among young Chinese MSM

> **NIH NIH R21** · YALE UNIVERSITY · 2020 · $246,845

## Abstract

PROJECT SUMMARY
Background. HIV prevalence among gay, bisexual, and other men who have sex with men (MSM) in China
has increased from less than 1.0% in 2003 to 9.2% in 2016. Lack of action will lead to 1 in 6 Chinese MSM
being infected with HIV by 2025; the majority will be young (YMSM). Stigma fuels China’s HIV epidemic among
YMSM. Chinese YMSM face a lack of equal rights and legal protections, identity concealment is normative,
and conversion therapy is widespread. Chinese values of filial piety and norm conformity further strain YMSM.
This stigma gives rise to minority stress reactions, including identity concealment, internalized homonegativity,
and sensitivity to identity-based rejection. Both minority stress and associated poor mental health compromise
YMSM’s HIV prevention through avoidance coping, low self-worth, impulsivity, and unassertiveness. Our team
has created the first intervention tested for efficacy with YMSM that addresses these minority stress reactions
and related processes. This cognitive-behavioral (CBT) intervention, called ESTEEM, shows strong preliminary
efficacy across minority stress, mental health, and HIV risk behavior. Yet, ESTEEM was developed in the US
and currently requires in-person delivery of 10 1-hour sessions, precluding widespread implementation in
China. Now, advancements in our research allow us to prepare ESTEEM for broad reach. Preliminary
Studies. First, we culturally adapted in-person ESTEEM for Chinese YMSM across an 8-stage adaptation
process with YMSM and stakeholders (n=56), including a small open pilot with Chinese YMSM (n=8). Second,
we worked with our colleagues in Sweden – world leaders in internet-based CBT (iCBT) – to create an iCBT
version of ESTEEM. iCBT combines a self-guided mobile platform with brief counselor feedback and online
exercises and homework, requiring 80% less counselor time than in-person ESTEEM. In a small US pilot
(n=10), iCBT ESTEEM was highly functional. We incorporate these advances to develop Chinese ESTEEM
iCBT – a highly efficient, private intervention that addresses minority stress and mental health as HIV
prevention. Aims. (1) Transform our recently created Chinese ESTEEM in-person materials (e.g., manual,
handouts) into iCBT content (e.g., self-guided exercises, videos) and ensure its comprehension (n=10 YMSM).
(2) Test the initial efficacy of Chinese ESTEEM iCBT for reducing at-risk YMSM’s past-90-day HIV-risk
behavior, against a weekly self-monitoring control. (3) Identify implementation barriers and facilitators of
Chinese ESTEEM iCBT through analysis of Aim 2 data (e.g., counselor fidelity) and qualitative interviews with
Aim 2 participants (n=20), counselors (n=4), government stakeholders (e.g., Chinese CDC, medical clinic staff,
n=12), and implementing partners (e.g., HIV-prevention NGOs, LGBTQ centers, n=12). In developing a highly
efficient platform to disseminate our minority stress-mental health intervention, we also position ourselves for
sustained fut...

## Key facts

- **NIH application ID:** 10055475
- **Project number:** 1R21TW011762-01
- **Recipient organization:** YALE UNIVERSITY
- **Principal Investigator:** Xianhong LI
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $246,845
- **Award type:** 1
- **Project period:** 2020-08-01 → 2022-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10055475

## Citation

> US National Institutes of Health, RePORTER application 10055475, Developing efficient intervention technologies to reduce stigma-related stress, mental health problems, and HIV risk among young Chinese MSM (1R21TW011762-01). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10055475. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*