Newly diagnosed HIV-positive men who have sex with men (MSM) often face significant psychological stress, resulting in a high prevalence of issues such as anxiety and depression. Sense of coherence, an internal strength factor, is known to offer protective effect against health challenges. However, interventions specifically designed to enhance sense of coherence in this population remain limited.

To evaluate the effectiveness of the salutogenic strength-based intervention in enhancing sense of coherence as the primary outcome and improving related health outcomes as secondary outcomes, including stress, depression, and antiretroviral therapy adherence, CD4+ T cell count and viral load, among newly diagnosed HIV-positive men who have sex with men.

This randomized controlled trial involved random assignment of participants to either the intervention or control group in a 1:1 ratio.

Participants were recruited through Changsha First Hospital and Changsha Zhongda Sunshine Social Work Service Center.

A total of 70 participants were included in the study.

The intervention group participated in an 8-week “Towards the Sun” program delivered via the WeChat platform, while the control group received standard follow-up care. Outcomes were measured at baseline (T1), post-intervention (T2), and three months post-intervention (T3). Generalized Estimating Equations were used to analyze the intervention effects over time.

The intervention group demonstrated a significant increase in sense of coherence scores from T1 to T3 (ME = 10.23, 95%CI 7.14–13.31, p < 0.001), whereas the control group showed a declining trend from T1 to T3 (ME = -7.35, 95%CI -10.39- -4.32, p < 0.001). Stress in the intervention group significantly decreased at T3 compared to T1 (ME = − 3.66, 95%CI -5.56- -1.76, p < 0.001), while the control group experienced a significant increase (ME = 1.93, 95%CI 0.06–3.80, p = 0.043). Additionally, depression only increased in the control group (ME = 3.17, 95%CI 1.53–4.81, p < 0.001) and was significantly lower in the intervention group than that in the control group at T3 (ME = -3.21, 95%CI -5.76-0.65, p = 0.014). Antiretroviral therapy adherence remained stable in the intervention group but declined significantly in the control group (ME = -1.31, 95%CI -2.10- -0.52, p = 0.001). No significant differences were found between groups regarding CD4+ T cell count or viral load.

The salutogenic strength-based intervention significantly enhanced sense of coherence, reduced stress and depression, and maintained antiretroviral therapy adherence among newly diagnosed HIV-positive men who have sex with men. These findings indicate substantial potential for improving psychological health and adherence behaviors through targeted interventions in this population.

Tweetable abstract: A salutogenic strength-based intervention delivered via WeChat improved sense of coherence, reduced stress and depression, and maintained therapy adherence among newly diagnosed HIV-positive men who have sex with men.