Intersectional discrimination and linkage to HIV prevention and care in transgender women in Ecuador

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7. Project Summary-Abstract Latin America did not achieve any reductions in new HIV cases in the last decade. In Ecuador, transgender women—those who identify as women or on the transfeminine spectrum and who were assigned a male sex at birth—who have sex with cisgender men are a key population in the HIV epidemic. HIV prevalence in Ecuador is between 20.7%-34.8% among transgender women—the highest in Latin America. Studies are urgently needed to guide HIV prevention and care efforts to curb HIV Infection rates. People with multiple marginalized identities, such as transgender women of African descent living in poverty, are at higher risk of exposure to intersectional discrimination than the general U.S. population and have high rates of HIV. Yet the extent to which Ecuadorian transgender women are burdened by intersectional discrimination and its effect on the linkage to HIV prevention and care outcomes remains unknown. This K01 Award will provide the candidate with training in intersectional qualitative, quantitative, intervention development, and grant writing to address the challenge of intersectional discrimination and HIV burden in transgender women in Ecuador. The proposed research will assess the mechanisms through which intersectional discrimination exerts its impact on linkage to HIV prevention and care for transgender women in Ecuador while extending and deepening candidate’s research skills. In Research Aim 1, the candidate will assess experiences of intersectional discrimination (e.g., HIV stigma, racism, classism) in relation to HIV prevention and care through in-depth qualitative interviews with transgender women (Training Aim 1: application of intersectionality to qualitative methods). In Research Aim 2, the candidate will conduct a survey to characterize and longitudinally test the pathways that link intersectional discrimination with HIV prevention and care linkage outcomes over a 6-month period (Training Aim 2: epidemiological methods and longitudinal quantitative research design). In Research Aim 3, the candidate will implement the first six phases of the systematic ADAPT-ITT model to adapt an HIV intervention for transgender women (Training Aim 3: skills for intervention development). Findings from this study and training will position the candidate to develop an R01 proposal to implement remaining steps of the ADAPT-ITT model and conduct a randomized controlled trial of the intervention (Training Aim 4: grant writing). As an Ecuadorian non-binary queer U.S. immigrant researcher, the candidate has the cultural and research background to leverage this proposed K01 to transition to career independence and address key knowledge and intervention gaps for HIV prevention and care in Ecuador.