Trauma-Informed Investigation of TGNBI Experiences in HIV Stigma Research

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7. PROJECT SUMMARY Transgender and non-binary individuals (TGNBI) have received increasing attention within HIV research, with studies documenting the pervasive role stigma plays in creating and sustaining health inequities. However, the proliferation of HIV stigma research with this population has also raised concerns about research practices that may unintentionally stigmatize or re-traumatize the very communities they are designed to benefit. Conducting stigma research is critical for generating accurate information about HIV epidemiology, risk and protective factors, and intervention strategies for TGNBI. Yet little, if any, research has directly examined the experiences of TGBNI when participating in these studies, or identified specific research practices (e.g., recruitment materials/study framing, choice of specific survey measures, data collection protocols, researcher behaviors) that may influence study participation, retention, and data quality. Equally important, research has not adequately examined the potential for unintended harm due to emotional distress experienced by participating in such research and what specific strategies might mitigate against potential distressful research experiences. To make meaningful strides in stigma research, it is imperative to develop a set of empirically-grounded practical recommendations for conducting this research with TGNBI in a manner that is person-centered, trauma informed, and actively de-stigmatizing. This area of inquiry is timely and particularly relevant given the NIH’s commitment to building investigators’ capacity for conducting intersectional multidisciplinary stigma research. In October 2021, the NIH released a Stigma and Discrimination Research Toolkit, which is an important contribution to health-related stigma research and represents a foundational shift towards addressing stigma through a health equity framework. However, one of the critical gaps in this toolkit is the lack of research examining experiences of stigma within the research context and identifying strategies for improving data quality and reducing unintentional harm in study recruitment, methodology, and/or implementation. As such, the specific aims of this exploratory R21 project are to: (1) Conduct in-depth interviews with TGNBI, stratified by gender identity and HIV status, to better understand how TGNBI understand and experience participation in HIV related stigma and discrimination research; (2) Conduct in-depth interviews with both investigators who conduct HIV-related stigma and discrimination research with TGNBI and mental health professionals who provide care to TGNBI to better understand perceptions of and experiences with conducting stigma and discrimination research with TGNBI, and compile existing strategies for mitigating harm; and (3) Utilize a modified Delhi technique to develop a set of empirically-informed guidelines for conducting HIV stigma research with TGNBI. The present study will be the first (to our knowledge) to develop evidence-based research guidelines to: a) increase researchers’ capacity to recruit and retain TGNBI in HIV-related stigma research, b) enhance the quality of data collected; and c) reduce unintentional harm in HIV stigma research methodology.