Reducing Intersectional Stigma among High-Risk Women in Brazil to Promote Uptake of HIV Testing and PrEP

减少巴西高危女性的交叉耻辱，促进艾滋病毒检测和 PrEP 的普及

• 批准号: 10404665
• 负责人: Sheri Ann Lippman
• 金额: $ 67.46万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-14 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10404665
• 关键词: AIDS prevention; Address; Adherence; Brazil; Clinic; Clinical; Communities; Data; Data Collection; Economics; Educational Curriculum; Event; Gender; General Population; HIV; HIV Infections; Harm Reduction; Health; High Risk Woman; Human immunodeficiency virus test; Individual; Intervention; Investigation; Measures; Modeling; Monitor; Names; Outcome; Participant; Patient Self-Report; Pharmaceutical Preparations; Population; Prevention; Prevention Research; Prevention strategy; Public Sector; Race; Randomized; Records; Research; Risk; Schedule; Secondary Prevention; Self Care; Sexual Health; Social Environment; Social Identification; Social status; Surveys; System; Testing; Time; Training; United States; Waiting Lists; Woman; Work; acceptability and feasibility; arm; base; clinical research site; cohort; comparison intervention; condoms; design; effective intervention; experience; health disparity; health disparity populations; high risk; interest; internalized stigma; multidisciplinary; novel; outreach; peer; post intervention; pre-exposure prophylaxis; prevention service; programs; recruit; resilience; scale up; self testing; sex; social; social exclusion; social stigma; substance use; testing uptake; theories; therapy development; transgender; transgender women; treatment arm; uptake

PROJECT SUMMARY Globally, transgender (`trans') women experience extreme social and economic marginalization due to intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities and positions among those who are multiply oppressed. Among trans women, gender-based stigma intersects with social positions such as engagement in sex work and substance use, as well as race-based stigma to generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the `most-at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population; further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower than other at-risk groups, despite availability in the public sector and documented interest in the community. Through extensive formative work, we have developed a multi-level intervention utilizing HIV prevention strategies which have demonstrated feasibility and acceptability by trans women in Brazil, to address intersectional stigma and increase engagement of trans women in the HIV prevention continuum. We propose to test `Guerreiras' (`warrior women', as named by trans women participants in Brazil), comprised of two intervention components designed to address intersectional stigma: 1) a group-level, peer-led intervention and 2) an individual-level peer navigation program to increase uptake of HIV testing and PrEP. Guerreiras is informed by a trans-specific conceptual model, gender affirmation theory, that describes intersectional stigma faced by trans women, informs investigations of how intersectional stigma results in health disparities, and provides a framework for intervention development and testing. We will recruit trans women (N=400) from clinical sites, outreach events, and an observational cohort in São Paulo, Brazil. Guerreiras will be evaluated using a randomized wait-list controlled trial to compare HIV testing uptake (self-testing and clinic-based) (Aim 1), PrEP initiation and persistence (Aim 2), and other prevention services (e.g. harm reduction) among trans women in the intervention arm compared to those in the control arm with data collection scheduled every three months. We will assess changes in intersectional stigma (Aim 3), including reductions in internalized stigma and increased resilience to anticipated and enacted stigma, among those assigned to intervention compared to those assigned to control, and assess how changes in stigma domains result in prevention uptake. Outcomes will be monitored through the national medications dispensing system (PrEP initiation and persistence), clinical records and self-report (HIV testing), and through comprehensive surveys (intersectional stigma). The proposed research leverages a productive multi-disciplinary HIV research partnership with extensive experience working with trans women in Brazil, multi-level intervention components, and a context where PrEP and HIVST are available publicly, providing an opportunity to evaluate and scale-up an HIV prevention initiative in a key health disparity population, while contributing to nascent research in intersectional stigma.

项目摘要 在全球范围内，跨性别者（“跨性别”）妇女经历了由于 交叉污名，被定义为由社会身份交集产生的污名的汇合 以及那些被压迫的人的位置。在跨性别的妇女中，基于性别的污名相交 具有社会立场，例如从事性工作和毒品使用，以及基于种族的污名 产生脆弱性和增加艾滋病毒风险的社会背景。在巴西，跨性别女性是 艾滋病毒的“最危险”组，艾滋病毒感染的估计几率是普通人群的55倍； 此外，跨性别女性的艾滋病毒测试和暴露前预防（PREP）的吸收显着降低 比其他高危人群，公共部门的目的地可用性，并记录了社区的兴趣。 通过广泛的形成性工作，我们采用了预防HIV的多层干预措施 在巴西表现出可行性和可接受性的策略，以解决 交叉污名和增加跨性别女性在HIV预防连续体中的参与度。我们建议 测试``gueerreiras''（``战士妇女''，由巴西的跨性别女性参与者命名），由两个人组成 干预组件旨在应对交叉污名：1）组级，同行主导的干预措施和 2）一个个别级别的同伴导航计划，以增加对HIV测试和PREP的吸收。 Guerreiras是 以跨性别概念模型，性别肯定理论的了解，该理论描述了交叉污名 面对跨性别妇女，向调查介绍了交叉污名如何导致健康差异，以及 为干预开发和测试提供了一个框架。我们将从 巴西圣保罗的临床场所，外展活动和观察队列。 Guerreiras将进行评估 使用随机等待名单对照试验比较HIV测试摄取（基于自我测试和诊所）（AIM 1），准备计划和持久性（AIM 2）以及跨性别的其他预防服务（例如减少伤害） 与对照组中的妇女相比，与对照组的妇女相比，计划收集每三个 月份。我们将评估交叉污名的变化（AIM 3），包括减少内部污名 并提高了对预期和制定的污名的韧性，与分配给干预的污名相比 分配给控制的人，并评估污名域的变化如何导致预防吸收。结果 将通过国家药物分配系统（准备和持久性），临床来监控 记录和自我报告（HIV测试），并通过全面的调查（交叉污名）。 拟议的研究利用了一项富有生产力的多学科艾滋病毒研究伙伴关系 与巴西的跨性别妇女合作的经验，多层干预组件以及准备的情况 和HIVST公开可用，提供了一个机会，以评估和扩大预防艾滋病毒的预防 在关键的健康差异人群中，同时促进了交叉污名的新生研究。