A Mobile Counseling Program for Gay and Bisexual Men’s Mental, Behavioral, and Sexual Health in Eastern Europe: A Randomized Controlled Trial

In Romania, the HIV epidemic attributed to male-to-male sexual contact is high, due to multiple sociocultural manifestations of stigma toward gay, bisexual, and other men who have sex with men (GBM), which is associated with inadequate HIV prevention. The current analyses describe the results of an intervention aiming to reduce HIV risk and heavy alcohol use, and improve mental health and minority stress-related outcomes, among GBM in Romania. Between 2019 and 2023, 300 Romanian GBM reporting HIV risk and heavy alcohol use were randomized to receive eight 1-h text-based live counseling sessions (the Comunica condition) or self-directed online educational control modules, both informed by the Information-Motivation-Behavior (IMB) model and minority stress theory. Self-reported assessments were conducted at baseline and at 4-, 8-, and 12-month follow-ups; HIV and STI testing was self-administered at baseline and 12-month follow-up. Analyses compared the conditions in terms of their impact on the primary outcome - past-30-day HIV-transmission-risk behavior. Secondary outcomes included mental (e.g., depression symptoms) and behavioral health (e.g., alcohol use) measures. We also examined between-condition change in hypothesized IMB and minority stress mechanisms. The conditions did not significantly differ in any primary or secondary outcomes over time. Both conditions demonstrated decreases in past-30-day HIV-transmission-risk behavior, number of heavy drinking days, depression and anxiety symptoms, and suicidal ideation over the 12-month follow-up period. Education control participants reported significantly greater increases in alcohol- and HIV/AIDS-related knowledge, while Comunica participants reported significantly greater decreases in perceived benefits of condomless sex across the follow-up period. Both conditions showed improvements in self-efficacy for condom use and alcohol use reduction and in all minority stress factors across the follow-up period. As all participants reported similar improvements across outcomes, future research is needed to determine how to best support this stigmatized population's health given the limited population-specific supports.