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

项目概要 菲律宾马尼拉大学 (UPM) 和布朗大学之间的合作响应了 PAR-19-326（减少耻辱感以改善中低收入人群的艾滋病毒/艾滋病预防、治疗和护理 收入国家）提出严格的程序来制定和试点测试性别肯定和耻辱 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 为菲律宾跨性别女性 (TW) 提供预防/护理和性别相关服务。 TW优先 菲律宾是世界上艾滋病毒流行增长最快的国家之一 目前正在发生。性别少数群体的耻辱是菲律宾台湾人参与艾滋病毒服务的一个重要障碍，并且 性别平权干预措施可以抵消这一领域预期的和内在的性别少数群体耻辱 人口。目前，很少有证据支持的性别平权干预措施可以解决这一问题 性别少数群体的耻辱并满足中低收入国家和菲律宾的台湾人的独特需求 特别是。建立在性别少数压力框架和性别肯定模型以及我们的 之前的移动医疗研究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 由台湾同伴健康教育者提供的基于应用程序的干预（名为“Lakambini”），他们将提供 赋权和性别平权支持，让 TW 参与 HST 并提供必要的咨询， 推荐和导航服务支持。我们的第一个具体目标是进行定性的迭代阶段 研究为性别平权 HST 咨询、转介和导航支持协议提供信息 通过现有的基于移动应用程序的平台为艾滋病毒高风险的菲律宾台湾人提供服务。我们的第二个具体目标是 审查艾滋病毒自我检测的可行性、可接受性、安全性和初步变化（主要结果） 以及次要成果：与艾滋病毒预防或护理服务的联系；降低行为风险； 参与台湾的其他医疗、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离职面谈 确定进一步改进干预措施的领域，并确定干预措施的方法和设计特征 未来的随机对照试验将解决台湾人中性别少数群体的耻辱、性别肯定和艾滋病毒结果 设置。因此，这项 R21 探索性/开发资助将为后续的研究提供经验基础 用于完整 RCT 的 R 系列应用。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 为菲律宾的研究人员、跨性别艾滋病毒专业人士和倡导者提供发展。

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.