Adapting the Finding Respect and Ending Stigma around HIV (FRESH) Intervention for the Dominican Republic

项目总结 拟议的研究解决了对艾滋病毒携带者(PLWH)的高度耻辱，特别是性别 和性少数群体，通过 患者-提供者干预的适应和测试--寻找尊重并结束对艾滋病毒的污名 (新鲜)。多米尼加共和国是一个高度优先的环境，日益需要减少对艾滋病毒的污名 学习。加勒比地区的艾滋病毒负担位居世界第二，但仍未得到足够的援助 与艾滋病毒相关的污名研究资助。多米尼加共和国是占世界人口95%以上的5个国家之一。 所有加勒比地区的艾滋病毒感染；它也有一个非常集中的艾滋病毒流行，一个非常保守的社会 其中PLWH被污蔑，以及极低的国家病毒载量抑制率。要完成 本次先导性研究，提出了三个具体目标。目标1是探索来源、特征和后果 男男性行为者在医疗保健环境中遭受的艾滋病毒相关和跨部门污名 多米尼加共和国的男男性接触者和变性人妇女。为了实现目标1，我们将在以下方面进行定性研究： 与提供艾滋病毒护理的医护人员、公共卫生部门的焦点小组进行深度访谈，并深入 对变性女性的采访。目标2是调整Fresh来解决MSM经历的耻辱和 多米尼加共和国的变性妇女。我们将使用Adapt-ITT框架应用Aim 1的调查结果 为了系统地适应Fresh，这是一种已被用于减少医疗保健环境中的耻辱的干预措施 在非洲和美国。通过迭代过程，Fresh的每个版本都将与双方共享 公共卫生署和医护人员征求并纳入他们对改编的每个版本的反馈 干预。AIM 3将对修订后的新干预措施进行试点测试，以获得对其削减潜力的估计 污名化医护人员的态度和行为以及性行为和性侵犯报告的污名化经历 性别少数民族客户(主要)；以及第二次评估修订后的新鲜食品是否改善了药物和就诊情况 坚持不懈。作为目标3的一部分，我们将把英语艾滋病毒和跨部门污名量表翻译成西班牙语并进行测试 西班牙量表的信度，评估污名测量和相关结构在前后的变化 来自PLWH和医护人员的最新干预，测量所有影响的方向，并检查 干预前和干预后的HIV级联结果。我们假设，通过减少医疗保健中的耻辱 工作人员--通过他们对FRESH的参与--我们将改善艾滋病患者的总体结果 我们干预现场的持续护理，并与我们对照现场的结果进行比较。通过适应 并对讲西班牙语的加勒比海地区进行了新的干预测试，Fresh可能成为一种经过验证的， 多地区艾滋病毒和跨部门减少污名干预措施专门为 高度污名、文化保守、资源有限的社区；这样的科学发展将是 对加勒比和全球减少艾滋病毒污名的努力作出重大贡献。

PROJECT SUMMARY The proposed study addresses the high level of stigma against people living with HIV (PLWH), particularly gender and sexual minorities, that is embedded in the Dominican Republic’s HIV treatment system through the adaptation and testing of a patient-provider intervention -- Finding Respect and Ending Stigma around HIV (FRESH). The Dominican Republic is a high priority setting with an increasing need for HIV stigma reduction studies. The Caribbean holds the second highest regional burden of HIV in the world, yet receives insufficient HIV-related stigma research funding. The Dominican Republic is 1 of 5 countries that accounts for over 95% of all Caribbean HIV infections; it also has a significant concentrated HIV epidemic, a deeply conservative society in which PLWH are stigmatized, and an exceptionally low national viral load suppression rate. To accomplish this pilot study, three Specific Aims are proposed. Aim 1 is to explore sources, characteristics, and consequences of HIV-related and intersectional stigmas experienced in healthcare settings by men who have sex with men (MSM) and transgender women in the Dominican Republic. To accomplish Aim 1, we will conduct qualitative in- depth interviews with healthcare workers who provide HIV care, focus groups with PLWH, and in-depth interviews with transgender women. Aim 2 is to Adapt FRESH to address stigmas experienced by MSM and transgender women in the Dominican Republic. We will apply the Aim 1 findings using the ADAPT-ITT framework to systematically adapt FRESH, an intervention that has been employed to reduce stigma in healthcare settings in Africa and the United States. Through an iterative process, each revision of FRESH will be shared with both PLWH and healthcare workers to solicit and incorporate their feedback about each version of the adapted intervention. Aim 3 will pilot-test the revised FRESH intervention to obtain estimates of its potential to reduce stigmatizing attitudes and behaviors from healthcare workers and experiences of stigma reported by sexual and gender minority clients (primary); and secondarily assess if revised FRESH improves medication and visit adherence. As part of Aim 3, we will translate English HIV and intersectional stigma scales into Spanish and test the Spanish scales’ reliability, assess the change in stigma measures and related constructs before and after the FRESH intervention from PLWH and healthcare workers, measure the direction of all effects, and examine HIV cascade outcomes pre- and post-intervention. We hypothesize that by reducing stigmas in healthcare workers -- through their participation in FRESH -- we will improve aggregated patient outcomes across the HIV continuum of care at our intervention site and as compared to the outcomes from our control site. By adapting and testing the FRESH intervention for the Spanish-speaking Caribbean, FRESH could become a validated, multi-region HIV and intersectional stigma reduction intervention designed specifically for healthcare settings in high-stigma, culturally conservative, resource-constrained communities; such a scientific development would be a significant contribution to HIV stigma reduction efforts in the Caribbean and globally.