Community-Engaged Structural Approaches to Prevent Violence and Improve HIV Prevention and Care Outcomes Among Trans Women of Color

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PROJECT ABSTRACT This K01 application to NIMH will enable a concentrated four-year intensive training and mentored research program designed to transition Dr. Sarah Peitzmeier from her current observational research focus to a new research agenda designing and evaluating structural interventions within a community-based participatory research (CBPR) context for integrated HIV and violence prevention and mental health promotion, in partnership with trans women of color. Dr. Peitzmeier is an assistant professor at the University of Michigan School of Nursing and School of Public Health, which houses one of the oldest CBPR partnerships and academies nationally (the Detroit Urban Research Center) and is a powerhouse of HIV intervention research. Racism, sexism, HIV stigma, cisgenderism, and other interlocking forms of oppression generate mutually reinforcing structural vulnerabilities for trans women of color, including gender-based violence (GBV), poverty, homelessness, and sex work. These structural vulnerabilities synergistically interact to elevate risk of HIV. However, interventions to address these deeply entrenched upstream structural determinants of HIV in this population are limited, which in turn limits the efficacy of downstream individual behavioral interventions while these determinants remain intact. The proposed work will 1) Identify community priorities for a structural intervention for integrated HIV/GBV prevention through forming a CBPR partnership with trans women of color and service providers in Detroit and conducting an Action-Oriented Community Diagnosis, 2) Develop a grounded theory of how trans women's participation in a cash-plus cash transfer intervention affects their experience of GBV, HIV-related behaviors, and mental health, and 3) Collaboratively design a status-neutral intervention to promote HIV prevention and care, reduce mental health burden, and prevent GBV against trans women of color. The research will be underpinned by coursework in CBPR, structural interventions, intervention trial design, and implementation science, as well as invaluable mentored learning experiences observing the implementation and evaluation of diverse structural interventions (Drs. Darbes, Sherman, Gamarel, and Pettifor) and CBPR partnerships (Gamarel, Israel, Brush, Rivera) from renowned experts in the field. Overall, the research will generate rich preliminary data, a finalized intervention protocol, a concrete strategy for funding and implementing the intervention, a pilot hybrid efficacy-implementation trial design for evaluating the intervention, and a strong CBPR partnership as a fruitful platform for Dr. Peitzmeier's ongoing research agenda in partnership with this community. By supporting didactic and field-based learning and protected time for research and CBPR partnership building, a K01 will advance Dr. Peitzmeier's career progression as an independent, community-based HIV intervention scientist focused on structural determinants of health, leading to better health and wellbeing among trans women of color, an NIH priority population.