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
基本信息
- 批准号:10404665
- 负责人:
- 金额:$ 67.46万
- 依托单位:
- 依托单位国家:美国
- 项目类别:
- 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:
- 关键词:AIDS preventionAddressAdherenceBrazilClinicClinicalCommunitiesDataData CollectionEconomicsEducational CurriculumEventGenderGeneral PopulationHIVHIV InfectionsHarm ReductionHealthHigh Risk WomanHuman immunodeficiency virus testIndividualInterventionInvestigationMeasuresModelingMonitorNamesOutcomeParticipantPatient Self-ReportPharmaceutical PreparationsPopulationPreventionPrevention ResearchPrevention strategyPublic SectorRaceRandomizedRecordsResearchRiskScheduleSecondary PreventionSelf CareSexual HealthSocial EnvironmentSocial IdentificationSocial statusSurveysSystemTestingTimeTrainingUnited StatesWaiting ListsWomanWorkacceptability and feasibilityarmbaseclinical research sitecohortcomparison interventioncondomsdesigneffective interventionexperiencehealth disparityhealth disparity populationshigh riskinterestinternalized stigmamultidisciplinarynoveloutreachpeerpost interventionpre-exposure prophylaxisprevention serviceprogramsrecruitresiliencescale upself testingsexsocialsocial exclusionsocial stigmasubstance usetesting uptaketheoriestherapy developmenttransgendertransgender womentreatment armuptake
项目摘要
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.
项目概要
在全球范围内,跨性别女性因以下原因而经历极端的社会和经济边缘化:
交叉耻辱,定义为因社会身份交叉而产生的耻辱的融合
在那些遭受多重压迫的跨性别女性中,基于性别的耻辱是相互交叉的。
从事性工作和药物滥用等社会地位,以及基于种族的耻辱
在巴西,跨性别女性造成了脆弱性和感染艾滋病毒风险增加的社会环境。
艾滋病毒“高危”群体,估计感染艾滋病毒的几率比一般人群高 55 倍;
此外,跨性别女性对艾滋病毒检测和暴露前预防 (PrEP) 的接受率明显较低
尽管有公共部门的帮助并且社区有记录的兴趣,但仍高于其他高危群体。
通过广泛的形成工作,我们制定了利用艾滋病毒预防的多层次干预措施
已证明巴西跨性别女性的可行性和可接受性的战略,以解决
我们建议跨性别女性更多地参与艾滋病毒预防工作。
测试“Guerreiras”(巴西跨性别女性参与者所称的“女战士”),由两名
旨在解决交叉耻辱问题的干预措施:1)团体层面、同行主导的干预和
2) 一项旨在提高 HIV 检测和 PrEP 接受率的个人层面同伴导航计划。
受跨性别特定概念模型、性别肯定理论的启发,描述了交叉耻辱
跨性别女性面临的问题,为跨性别耻辱如何导致健康差异的调查提供信息,以及
提供了干预措施开发和测试的框架,我们将从中招募跨性别女性(N = 400)。
将评估巴西圣保罗的临床地点、外展活动和观察队列。
使用随机等待名单对照试验来比较 HIV 检测的采用情况(自我检测和基于临床的检测)(目标
1)、跨性别者中 PrEP 的启动和持续(目标 2)以及其他预防服务(例如减少伤害)
干预组中的女性与对照组中的女性进行比较,每三年收集一次数据
我们将评估交叉耻辱的变化(目标 3),包括内在耻辱的减少。
与接受干预的人相比,他们对预期和实施的耻辱的抵御能力增强
那些被分配控制的人,并评估耻辱领域的变化如何导致预防成果。
将通过国家药物配发系统(PrEP 启动和持续)、临床
记录和自我报告(艾滋病毒检测),以及通过综合调查(交叉耻辱)。
拟议的研究利用了富有成效的多学科艾滋病毒研究伙伴关系
在巴西与跨性别女性合作的经验、多层次干预措施以及 PrEP 的背景
和 HIVST 均公开提供,为评估和扩大 HIV 预防举措提供了机会
在关键的健康差异人群中,同时为交叉耻辱的新兴研究做出贡献。
项目成果
期刊论文数量(0)
专著数量(0)
科研奖励数量(0)
会议论文数量(0)
专利数量(0)
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Sheri Ann Lippman其他文献
Sheri Ann Lippman的其他文献
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{{ truncateString('Sheri Ann Lippman', 18)}}的其他基金
Training in implementation science research to improve PrEP services for people at risk for HIV
实施科学研究培训,以改善针对艾滋病毒高危人群的 PrEP 服务
- 批准号:
10532205 - 财政年份:2020
- 资助金额:
$ 67.46万 - 项目类别:
Exploring the Impact of Organizational Readiness and Inner Setting on Implementation of HIV Programming in South African Health Clinics
探索组织准备情况和内部环境对南非卫生诊所实施艾滋病规划的影响
- 批准号:
10245282 - 财政年份:2020
- 资助金额:
$ 67.46万 - 项目类别:
Training in implementation science research to improve PrEP services for people at risk for HIV
实施科学研究培训,以改善针对艾滋病毒高危人群的 PrEP 服务
- 批准号:
10308116 - 财政年份:2020
- 资助金额:
$ 67.46万 - 项目类别:
Exploring the Impact of Organizational Readiness and Inner Setting on Implementation of HIV Programming in South African Health Clinics
探索组织准备情况和内部环境对南非卫生诊所实施艾滋病规划的影响
- 批准号:
10082889 - 财政年份:2020
- 资助金额:
$ 67.46万 - 项目类别:
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:
10219381 - 财政年份:2019
- 资助金额:
$ 67.46万 - 项目类别:
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:
10166949 - 财政年份:2019
- 资助金额:
$ 67.46万 - 项目类别:
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:
10617361 - 财政年份:2019
- 资助金额:
$ 67.46万 - 项目类别:
Self-Conducted HIV Tests - Improving HIV Prevention in Key Populations
自行进行艾滋病毒检测——改善重点人群的艾滋病毒预防
- 批准号:
8790382 - 财政年份:2014
- 资助金额:
$ 67.46万 - 项目类别:
Self-Conducted HIV Tests - Improving HIV Prevention in Key Populations
自行进行艾滋病毒检测——改善重点人群的艾滋病毒预防
- 批准号:
9282847 - 财政年份:2014
- 资助金额:
$ 67.46万 - 项目类别:
Self-Conducted HIV Tests - Improving HIV Prevention in Key Populations
自行进行艾滋病毒检测——改善重点人群的艾滋病毒预防
- 批准号:
8898221 - 财政年份:2014
- 资助金额:
$ 67.46万 - 项目类别:
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