Sweekar - Multi-level intersectional stigma reduction to increase HIV testing and care engagement among trans women in Nepal

Sweekar - 多层次交叉耻辱减少，以增加尼泊尔跨性别女性的艾滋病毒检测和护理参与度

• 批准号: 10542580
• 负责人: Erin Meek
• 金额: $ 17.15万
• 依托单位: PUBLIC HEALTH FOUNDATION ENTERPRISES
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-07-01 至 2025-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10542580
• 关键词: AIDS prevention; Address; Adherence; Alcohol consumption; Asia; Attitude; COVID-19; Caring; Collaborations; Communities; Data; Diamond; Discrimination; Distress; Economics; Education; Employment; Failure; Frequencies; Funding; Gender; General Population; Geography; HIV; HIV risk; HIV-2; Health; Home; Human immunodeficiency virus test; Income; Individual; Interruption; Intervention; Knowledge; Media Campaign; Modeling; Nepal; Nongovernmental Organizations; Occupations; Outcome; Participant; Persons; Pharmaceutical Preparations; Policies; Population; Population Study; Positioning Attribute; Prevalence; Prevention; Prevention program; Psyche structure; Reduce health disparities; Research; Research Personnel; Services; Sexual Partners; Sexual and Gender Minorities; Site; Social support; Societies; Stigmatization; System; Testing; Time; United States National Institutes of Health; Unsafe Sex; Viral; Work; base; care delivery; design; empowerment; evidence base; experience; improved; innovation; internalized stigma; knowledge of results; low and middle-income countries; low income country; marginalized population; physical assault; prevent; prevention service; response; self testing; sex; sexual assault; sexual minority group; sexual risk behavior; social media; social stigma; transgender women; uptake

Trans women in low- and middle- income countries make up the largest proportion of trans women around the globe but are underserved in the response to HIV. Nepal is a lower income country in South Asia where trans women are a key population highly impacted by HIV. In 2019/20, we conducted an exploratory study with trans women finding that 11.3% were living with HIV, and only 70% were engaged in HIV care and virally suppressed. Discrimination resulting in anticipated HIV stigma and experienced anti-trans stigma was a main driver of low HIV testing and HIV care engagement. HIV risk was further exacerbated by anti-trans stigma resulting in barriers to education, employment, social support and empowerment. For example, because most trans women faced discrimination in job seeking, the majority of participants in our exploratory work did sex work for income and had high rates of condomless sex and many sexual partners. HIV Interventions for trans women are needed that will have sustained impact by addressing stigma at many levels that present barriers to health and wellness. However, few HIV prevention and treatment interventions tackle intersectional stigma, and even fewer are developed for low- and middle-income country settings. Building on evidence from our exploratory study, we propose to test a multi-level, HIV serostatus-neutral stigma reduction intervention called Sweekar, or acceptance in Nepali. The primary intervention outcomes are HIV testing and HIV care engagement. To increase HIV testing by addressing anticipated stigma, the individual level intervention component is a tailored HIV self-testing intervention. To increase ART adherence by addressing anticipated and experiences stigma, the systems level intervention component is HIV treatment home delivery. To address stigma at the community level, we will conduct a contact intervention11 informed by Photovoice12 to reduce experienced and internalized stigma. Photovoice will be used to inform content and delivery of a social media campaign to reduce anti-trans in Nepali society, with benefits for increasing social support and empowerment among trans women in Nepal, which will help mitigate internalized stigma. Our approach is community-driven and non-randomized to maximize benefit for trans women in immediate need of intervention, which is an essential practice to reduce health disparities. Feasibility is high as the US and Nepali researchers have forged a strong collaboration over the course of more than a decade working together to serve trans women in research and services. Furthermore, Covid-19 has created new opportunities for innovations HIV care and prevention that will be leveraged in Sweekar. If Sweekar is successful, we will immediately use the outcome data and lessons learned to develop multi-site R01 proposal to test the intervention at scale throughout Nepal and in partnership with our Nepali research and implementation team.

低收入国家和中低收入国家的跨性别妇女占跨性别妇女的最大比例 在全球范围内，但在对艾滋病毒的反应中却乏味。尼泊尔是南部的低收入国家 亚洲，跨性别妇女是受艾滋病毒影响很大的关键人群。在2019/20年，我们进行了一次 与跨性别妇女的探索性研究发现，有11.3％的人患有艾滋病毒，只有70％的人参与 艾滋病毒护理和病毒抑制。歧视导致预期的HIV污名和经历的抗trans 污名是低艾滋病毒测试和艾滋病毒护理参与度的主要驱动力。艾滋病毒风险进一步加剧了 反跨性别的污名导致了教育，就业，社会支持和赋权的障碍。为了 例如，由于大多数跨性别妇女在寻求求职方面都面临歧视，所以我们的大多数参与者 探索性工作是为了收入而进行性工作，并且没有避孕套的性行为和许多性伴侣。 需要针对跨性别妇女进行艾滋病毒干预措施，这将通过解决许多人的污名来持续影响 呈现健康和健康障碍的水平。但是，很少有艾滋病毒预防和治疗干预措施 针对低收入和中等收入的国家环境开发的交叉污名，甚至更少。 在我们的探索性研究的证据的基础上，我们建议测试多层次的HIV血清中性 污名降低干预措施称为Sweekar，或在尼泊尔接受。主要干预结果是 艾滋病毒测试和艾滋病毒护理参与。通过解决预期的污名来增加HIV测试，个人 水平干预组件是量身定制的艾滋病毒自我测试干预措施。通过增加艺术的依从性 解决预期和经历的污名，系统级干预部分是艾滋病毒治疗 送货上门。为了解决社区层面的污名，我们将进行联系干预11 通过Photovoice12减少经验丰富和内在的污名。光载将用于告知内容和 提供社交媒体运动，以减少尼泊尔社会的反交易，并有所增加 尼泊尔跨性别妇女之间的支持和授权，这将有助于减轻内在的污名。我们的 方法是由社区驱动的，非随机的，以最大程度地利用跨性别妇女的利益 干预，这是减少健康差异的重要做法。美国和尼泊尔人的可行性很高 在十多年的过程中，研究人员建立了强有力的合作 为跨性别妇女提供研究和服务。此外，Covid-19为 创新的艾滋病毒护理和预防将在Sweekar中利用。如果Sweekar成功，我们将 立即使用结果数据和经验教训来开发多站点R01建议来测试 整个尼泊尔的大规模干预，并与我们的尼泊尔研究和实施团队合作。