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）和布朗大学之间的合作， PAR-19-326（减少羞辱，改善中低收入群体的艾滋病毒/艾滋病预防、治疗和护理） 收入国家），提出了严格的程序，以制定和试点测试性别肯定和耻辱， 减少干预，以促进艾滋病毒自我检测（HST），行为风险降低，并使用相关的艾滋病毒 菲律宾变性妇女的预防/护理和性别相关服务。TW是一个优先事项 菲律宾是世界上艾滋病蔓延最快的国家之一， 目前正在进行。性别少数污名化是使菲律宾TW参与艾滋病毒服务的一个关键障碍， 性别平权干预措施可以抵消预期的和内在的性别少数污名， 人口目前，很少有证据支持的性别平等干预措施， 在中低收入国家和菲律宾， 尤其是。建立在性别少数压力框架和性别肯定模型，以及我们的 之前的移动健康研究使用移动的应用程序进行艾滋病毒预防和检测，我们将设计一个性别平等的 由TW同伴健康教育工作者提供的基于应用程序的干预（题为“Lakambini”）， 赋予妇女权力和提供性别平等支持，使妇女参与卫生和社会服务，并提供必要的咨询， 转介和导航服务的支持。我们的第一个具体目标是进行定性的迭代阶段， 研究，以告知性别平等的HST咨询，转介，和导航支持协议， 通过现有的基于移动的应用程序的平台为艾滋病毒高风险的菲律宾TW人提供。我们的第二个具体目标是 检查HIV自我检测的可行性、可接受性、安全性和初步变化（主要结局） 以及次要结果：与艾滋病毒预防或护理服务的联系;降低行为风险; 为TW从事其他医疗、社会或社区服务。我们将进行量化评估 在基线、3个月和6个月随访时。我们将对参与者进行定性离职面谈， 确定进一步改进干预措施的领域，并确定 未来的随机对照试验，以解决性别少数的耻辱，性别肯定，和艾滋病毒的结果之间的TW在这方面 设置.因此，R21探索/发展赠款将为随后的研究提供经验基础。 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合作，并将投资于能力建设， 在菲律宾，艾滋病研究人员和跨性别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.