Reducing Stigma and HIV Risk Behaviors among Kathoey in Bangkok, Thailand

减少泰国曼谷 Kathoey 的耻辱和艾滋病毒风险行为

基本信息

批准号：
10220166
负责人：
TOORU NEMOTO
金额：
$ 14.37万
依托单位：
PUBLIC HEALTH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2024-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10220166
关键词：
AIDS prevention Address Anti-Retroviral Agents Behavioral Buddhism Businesses Cellular Phone Cities Communities Control Groups Data Discrimination Drops Drug user Educational Curriculum Enrollment Environment Evaluation Exposure to Family Violence Feedback Female Financial Support Foundations Gender Identity HIV HIV Infections HIV Seroprevalence HIV prevention trial HIV risk HIV/STD Health Educators Health Promotion Healthcare Hormone use Hospitals Incidence India Individual Indonesia Institutes Intervention Intervention Studies Intervention Trial Mental Health Methods Military Personnel Motivation Oral Pakistan Participant Phase Pilot Projects Pregnant Women Prevalence Prevention program Procedures Process Protocols documentation Public Health Randomized Randomized Controlled Trials Reporting Research Research Personnel Risk Behaviors Social support Societies Solid Structure Substance abuse problem Techniques Thailand Training Treatment Efficacy Universities Vendor Work acceptability and feasibility base care systems condoms consistent condom use efficacy evaluation experience female sex worker follow up assessment follow-up gender expression health care service high risk high risk population implementation process innovation intervention program kathoey male male sex worker member men who have sex with men motivational enhancement therapy motivational intervention neglect pre-exposure prophylaxis prevention service preventive intervention programs recruit reduced substance use self esteem sex sexual risk behavior sexual violence sexually active social culture social factors social stigma substance use success transgender women transphobia uptake young man young woman

项目摘要

The proposed study will examine the acceptability, feasibility, and preliminary efficacy of an HIV prevention program aiming to reduce stigma, transpobia, and HIV risk behaviors among kathoey (transwomen) sex workers (KSWs) in Bangkok, Thailand. High HIV sero-prevalence has been reported among kathoey in Bangkok and other large cities in Thailand. KSWs engage in substance use and HIV risk behaviors and are exposed to unique individual, cultural, and social factors that elevate their vulnerability for HIV infection (e.g., gender identity and hormone use). There is a huge gap in HIV prevention studies targeting KSWs, particularly addressing stigma and transphobia. PrEP is available in Thailand through designated hospitals and demonstration projects; however, few KSWs have enrolled in PrEP. We propose to develop an HIV prevention intervention curriculum based on our previous projects targeting transwomen in the U.S., examine the acceptability and feasibility, and evaluate the preliminary efficacy of a pilot intervention. The intervention will adapt principles from an empirically supported HIV prevention intervention: Motivational Enhancement Intervention (MEI) and will develop culturally appropriate and innovative HIV prevention programs for KSWs (e.g., delivering follow-up MEI sessions through cellphone and utilizing street vendors for recruitment). The study team consists of researchers at Chulalongkorn University, Bangkok and the Public Health Institute in the U.S., and has ample experience in HIV prevention for KSWs and is well-grounded in the targeted kathoey communities. The specific aims of the study are: 1) To adapt HIV prevention MEI protocols for use with KSWs, we will conduct iterative phases of formative research based on discussions with the kathoey community advisory board (CAB) members, local experts, and street vendors, and revise the protocol; 2) To further refine the intervention protocol, we will recruit 16 KSWs and conduct a preliminary assessment of the feasibility and acceptability of the protocol and further integrate feedback into the protocol; 3) To explore preliminary effects of our adapted MEI intervention and examine trial implementation procedures, we will randomly assign 120 KSWs to either MEI delivered by trained kathoey health educators (KHEs) or a health promotion information- only control group. We will examine our primary hypothesis that participants receiving MEI are more likely to reduce stigma, transphobia, and substance use and sexual risk behaviors and increase self-esteem, social support, and enroll in PrEP at follow-up assessments compared with the control group. Through process evaluation, we will examine intervention acceptability, feasibility, fidelity, and implementation of the trial procedures; such as recruitment, randomization, and follow-up retention. The proposed study will provide a solid foundation for preparing an R01 application to examine the efficacy of the HIV prevention intervention program with behavioral (MEI) and biomedical (PrEP) components targeting KSWs in Thailand who are at high risk for HIV and substance abuse, but have been neglected by HIV prevention programs in Thailand.

拟议的研究将检验艾滋病毒预防的可接受性、可行性和初步效果旨在减少跨性别女性性别歧视、跨性别者和艾滋病毒风险行为的计划泰国曼谷的工人（KSW）。据报道，在 kathoey 中艾滋病毒血清流行率很高曼谷等泰国大城市。 KSW 从事药物滥用和艾滋病毒危险行为，并且暴露于独特的个人、文化和社会因素，这些因素增加了他们感染艾滋病毒的脆弱性（例如，性别认同和激素使用）。针对 KSW 的艾滋病毒预防研究存在巨大差距，特别是解决耻辱和跨性别者恐惧症。 PrEP 在泰国可以通过指定医院和示范项目；然而，很少有 KSW 参加 PrEP。我们建议开发一种艾滋病毒基于我们之前针对美国变性女性的项目的预防干预课程，检查可接受性和可行性，并评估试点干预的初步效果。干预将采用经验支持的艾滋病毒预防干预措施的原则：动机增强干预 (MEI) 并将为 KSW 制定文化上适当且创新的艾滋病毒预防计划（例如，通过手机提供后续 MEI 会议以及利用街头小贩进行招聘）。这研究小组由曼谷朱拉隆功大学和曼谷公共卫生研究所的研究人员组成美国，在 KSW 艾滋病毒预防方面拥有丰富的经验，并且在目标 kathoey 方面有扎实的基础社区。该研究的具体目标是： 1) 调整 HIV 预防 MEI 方案以与 KSW 一起使用，我们将根据与 kathoey 社区的讨论进行形成性研究的迭代阶段顾问委员会（CAB）成员、当地专家和街头小贩，并修订协议； 2）进一步细化根据干预方案，我们将招募16名KSW，并对可行性进行初步评估协议的可接受性并进一步将反馈整合到协议中； 3）探索初步效果根据我们改编的 MEI 干预措施并检查试验实施程序，我们将随机分配 120 由经过培训的凯瑟伊健康教育者 (KHE) 向 MEI 提供的 KSW 或健康促进信息 - 仅对照组。我们将检验我们的主要假设，即接受 MEI 的参与者更有可能减少耻辱感、变性恐惧症、药物滥用和性风险行为，并增强自尊、社交能力支持，并在后续评估中与对照组相比参加 PrEP。通过过程评估，我们将检查干预措施的可接受性、可行性、保真度和试验的实施程序；例如招募、随机化和后续保留。拟议的研究将提供为准备 R01 申请以检查艾滋病毒预防干预措施的有效性奠定了坚实的基础包含行为 (MEI) 和生物医学 (PrEP) 内容的计划，针对泰国的 KSW 艾滋病毒和药物滥用的高风险，但在泰国的艾滋病毒预防计划中却被忽视了。