"Safe Places Like These are Rare": Feasibility of the Speaking Out and Allying Relationships (SOAR) Intervention for HIV-Positive Sexual Minority Men in Eastern Cape, South Africa.

In South Africa, sexual minority men (SMM) with HIV exhibit low rates of antiretroviral treatment (ART) adherence. Self-efficacy in disclosing HIV status is known to mediate ART adherence, as SMM may stop ART to avoid unintentional disclosure to family or partners. To address this, we developed "Speaking Out and Allying Relationships" (SOAR), a five-session intervention to improve HIV coping and disclosure skills. We assessed SOAR feasibility using a pilot randomized controlled trial design. SMM in a relationship with sub-optimal ART adherence were consented and block-randomized into SOAR or attention match control (AMC). Feasibility, behavioral and biomedical assessments were completed at baseline, mid- and post-intervention (Weeks 9, 17). Qualitative interview data were analyzed using a thematic approach; quantitative assessment data were analyzed using inferential statistics. 105 SMM enrolled in SOAR (n = 51) and AMC arms (n = 54). Participants were 19-56 years of age (mean = 31). Study retention at week 17 follow up was 94% for SOAR and 92% for AMC arm participants. Feasibility assessments demonstrated 'Good to High' ratings (100%) for content acceptability, safety, and confidentiality. From baseline to Week 17 follow-up, SOAR participants showed improvements in HIV viral suppression (67% to 77%, ns), Relationship Values (5.9 to 6.6; p < 0.01) and Sex Coping (18.3 to 20.1; p < 0.05). Interview findings revealed increased disclosure decisions and use of coping strategies. SOAR is a feasible intervention, building skills among SMM to manage and strengthen relationships with family and partners for improved treatment engagement.