Stigma Reduction and Gender Affirmation to Promote HIV Prevention/Testing in Trans Women

项目摘要 菲律宾马尼拉大学(UPM)和布朗大学的这项合作回应了 PAR-19-326(减少耻辱，改善中低位艾滋病毒/艾滋病的预防、治疗和护理 收入国家)，提议制定和试点性别肯定和污名测试的严格程序-- 减少干预措施，以促进艾滋病毒自我检测(HST)、减少行为风险和使用相关艾滋病毒 菲律宾为变性妇女(TW)提供的预防/护理和与性别有关的服务。TW是优先考虑的 菲律宾人口对艾滋病毒的干预研究，那里是世界上增长最快的疫情之一 目前正在进行。性别少数的污名是让菲律宾妇女参与艾滋病毒服务的关键障碍，以及 性别平权干预可以抵消预期和内化的性别少数人在这方面的污名 人口。目前，几乎没有证据支持的性别平权干预措施来解决 性别-少数民族污名和满足TW在整个LMIC和菲律宾的独特需求 尤其是。以性别少数群体压力框架和性别肯定模式为基础，以及我们的 在之前的移动健康研究中，使用移动应用程序进行艾滋病毒预防和检测，我们将设计一个性别肯定的 由TW同伴健康教育者提供的基于APP的干预(名为“Lakambini”)，他们将提供 赋权和性别平等支持，以使妇女参与卫生和社会服务部，并提供必要的咨询， 推荐，以及对导航服务的支持。我们的第一个具体目标是进行定性的迭代阶段 为性别肯定的HST咨询、转诊和导航支持协议提供信息的研究将是 通过现有基于移动应用程序的平台为感染艾滋病毒风险较高的菲律宾TW提供服务。我们的第二个具体目标是 检查HIV自检的可行性、可接受性、安全性和初步变化(主要结果) 以及次要结果：与艾滋病毒预防或护理服务的联系；减少行为风险； 参与TW的其他医疗、社会或社区服务。我们将进行量化评估 在基线、3个月和6个月的随访中。我们将对参与者进行定性的离职访谈，以 确定需要进一步改进的干预领域，并确定方法和设计特点 未来的RCT将解决少数性别歧视、性别肯定和TW中艾滋病毒结果的问题 布景。因此，这项R21探索性/开发性赠款将为随后的 适用于完整RCT的R系列应用程序。我们的方法建立在并扩展了我们团队的协作经验 与菲律宾的性别和性少数群体社区合作，并将投资于能力 菲律宾研究人员和变性人艾滋病毒专业人员和倡导者的发展。

Project Summary This collaboration between University of the Philippines Manila (UPM) and Brown University responds to PAR-19-326 (Reducing Stigma to Improve HIV/AIDS Prevention, Treatment and Care in Low- and Middle- Income Countries) by proposing rigorous procedures to develop and pilot test a gender-affirmation and stigma- reduction intervention to promote HIV self-testing (HST), behavioral risk reduction, and use of relevant HIV prevention/care and gender-related services for transgender women (TW) in the Philippines. TW are a priority population for HIV intervention research in the Philippines, where one of the world’s fastest growing epidemic currently takes place. Gender-minority stigma is a critical barrier to engaging Filipina TW in HIV services, and gender-affirmative interventions can counteract anticipated and internalized gender-minority stigma in this population. Currently, there are few evidence-supported gender-affirmative interventions for addressing gender-minority stigma and meeting the unique needs of TW in LMICs generally, and in the Philippines particularly. Building on the Gender Minority Stress framework and Gender Affirmation Model, as well as our prior mHealth research using mobile apps for HIV prevention and testing, we will design a gender-affirmative app-based intervention (entitled “Lakambini”) delivered by TW peer health educators, who will offer empowerment and gender-affirmative support to engage TW in HST and provide necessary counseling, referrals, and support in navigating services. Our first specific aim is to conduct iterative phases of qualitative research to inform gender-affirmative HST counseling, referrals, and navigation support protocols to be delivered via existing mobile app-based platforms for Filipina TW with high HIV risk. Our second specific aim is to examine the feasibility, acceptability, safety, and preliminary changes on HIV self-testing (primary outcome) as well as secondary outcomes: linkage to HIV prevention or care services; behavioral risk reduction; engagement in other medical, social, or community services for TW. We will conduct quantitative assessments at baseline, 3-month, and 6-month follow-ups. We will conduct qualitative exit interviews with participants to identify areas for further intervention improvement and identify methodological and design characteristics for a future RCT to address gender-minority stigma, gender affirmation, and HIV outcomes among TW in this setting. This R21 Exploratory/Developmental grant will thus provide the empirical foundation for a subsequent R-series application for a full RCT. Our approach builds on and extends our team’s collaborative experience working with gender and sexual minority communities in the Philippines, and will invest in capacity development for researchers and transgender HIV professionals and advocates in the Philippines.