'Journeys to mental health and HIV wellness: adapting a community-based group program from Nigeria to Washington, DC

Background: Evidence-based programs are needed to address the multiple stigmas and disproportionately poor mental health and HIV-related outcomes that marginalized populations often face. In this implementation science study, we adapted a community-based program that we originally developed and tested in Lagos, Nigeria, to the Washington, DC context. Methods: We used the ADAPT-ITT framework to guide a multi-stage adaptation process in 2024. We conducted four serial focus group discussions with the same six Black gay or bisexual men (GBM), to review the original 4-session curriculum. We also conducted in-depth interviews with additional GBM (n=7), and other stakeholders (n=8) including local health department staff and HIV and mental health service providers, and held informal discussions with cognitive behavioral therapy (CBT) and stigma experts. We explored curriculum relevance, acceptability, feasibility, delivery format, and anticipated effects. Subsequent baseline surveys from a pilot evaluation with Black GBM (n=63) assessed psychosocial well-being using validated scales. Results: Community members and other stakeholders considered the program acceptable, feasible, appropriate, and needed in the local context. Core elements from the original intervention were retained, including its HIV status-neutral approach (i.e., with activities appropriate both for HIV prevention and treatment), four-session structure, and delivery by community health educators within community-based organizations. Adapted content emphasized critical reflection around multiple stigmas and their internalization, affirming identities, CBT skill-building, and HIV self-care and wellness. Components promoting shared resilience were strengthened, inspiring the program name, Journeys of Shared Resilience. Baseline survey data highlighted high levels of depression and internalized stigma alongside high personal resilience, underscoring the salience of the program. Conclusions: Using a systematic, community-partnered approach, we successfully adapted an evidence-based program for Black GBM in Washington, DC. Journeys represents a promising status-neutral approach to addressing multiple stigmas, mental health, and HIV prevention and care. Pilot testing is ongoing.