Adapting the Finding Respect and Ending Stigma around HIV (FRESH) Intervention for the Dominican Republic

项目摘要 拟议的研究涉及艾滋病毒感染者（PLWH）的高度耻辱化，特别是性别 多米尼加共和国的艾滋病毒治疗系统， 病人-提供者干预措施的调整和测试-找到尊重和消除艾滋病毒的污名 （新鲜）。多米尼加共和国是一个高度优先的国家，越来越需要减少艾滋病毒污名化 问题研究加勒比地区是世界上艾滋病毒感染率第二高的区域，但得到的援助不足。 艾滋病毒相关污名研究基金。多米尼加共和国是五个国家之一，占95%以上， 所有加勒比艾滋病毒感染;它也有一个显着的集中艾滋病毒流行，一个非常保守的社会 其中艾滋病毒携带者和艾滋病病毒携带者被污名化，全国病毒载量抑制率极低。完成 在本次试点研究中，提出了三个具体目标。目的1是探索来源、特征和后果 男男性行为者和变性妇女在医疗机构中经历的艾滋病毒相关和交叉污名 为FRESH的适应提供信息。为了实现目标1，我们将进行定性深入访谈， 提供艾滋病护理的医护人员、男男性接触者焦点小组以及对跨性别者的深入访谈 妇女目标2是调整FRESH，以解决男男性行为者和变性妇女在 多明尼加.我们将使用ADAPT-ITT框架应用目标1的发现， FRESH是一种干预措施，已被用于减少非洲和美国医疗机构的耻辱感。 States.通过迭代过程，FRESH的每次修订都将与PLWH和医疗保健部门共享 工作人员征求并纳入他们对每个版本的适应性干预的反馈。目标3将试点- 测试适应的干预措施，以获得其减少污名化态度和行为的能力的估计， 性和性别少数群体（SGM）和非SGM客户报告的HWs和羞辱经历 与艾滋病毒（主要）;同时探索如果新鲜有可能影响临床水平的艾滋病毒级联结果。 通过调整和测试FRESH在加勒比西班牙语地区的干预措施，FRESH可以成为一个 经过验证的、多地区的艾滋病毒和跨部门的减少耻辱干预措施，专门为医疗保健设计 在高耻辱，文化保守，资源有限的社区设置;这样的科学 在加勒比地区和全球范围内，艾滋病毒/艾滋病防治工作将是对减少艾滋病毒污名化努力的重大贡献。

PROJECT SUMMARY The proposed study addresses the high level of stigma against people living with HIV (PLWH), particularly gender and sexual minorities, that is embedded in the Dominican Republic’s HIV treatment system through the adaptation and testing of a patient-provider intervention -- Finding Respect and Ending Stigma around HIV (FRESH). The Dominican Republic is a high priority setting with an increasing need for HIV stigma reduction studies. The Caribbean holds the second highest regional burden of HIV in the world, yet receives insufficient HIV-related stigma research funding. The Dominican Republic is 1 of 5 countries that accounts for over 95% of all Caribbean HIV infections; it also has a significant concentrated HIV epidemic, a deeply conservative society in which PLWH are stigmatized, and an exceptionally low national viral load suppression rate. To accomplish this pilot study, three Specific Aims are proposed. Aim 1 is to explore sources, characteristics, and consequences of HIV-related and intersectional stigmas experienced in healthcare settings by MSM and transgender women to inform the adaptation of FRESH. To accomplish Aim 1, we will conduct qualitative in-depth interviews with healthcare workers who provide HIV care, focus groups with MSM, and in-depth interviews with transgender women. Aim 2 is to adapt FRESH to address stigmas experienced by MSM and transgender women in the Dominican Republic. We will apply the Aim 1 findings using the ADAPT-ITT framework to systematically adapt FRESH, an intervention that has been employed to reduce stigma in healthcare settings in Africa and the United States. Through an iterative process, each revision of FRESH will be shared with both PLWH and healthcare workers to solicit and incorporate their feedback about each version of the adapted intervention. Aim 3 will pilot- test the adapted intervention to obtain estimates of its ability to reduce stigmatizing attitudes and behaviors from HWs and experiences of stigma reported by sexual and gender minorities (SGM) and non-SGM clients living with HIV (primary); while exploring if FRESH has the potential to influence clinic-level HIV cascade outcomes. By adapting and testing the FRESH intervention for the Spanish-speaking Caribbean, FRESH could become a validated, multi-region HIV and intersectional stigma reduction intervention designed specifically for healthcare settings in high-stigma, culturally conservative, resource-constrained communities; such a scientific development would be a significant contribution to HIV stigma reduction efforts in the Caribbean and globally.