Addressing Economic Marginalization to Improve HIV Prevention and Care Outcomes Among Gender Minorities in the United States

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7. PROJECT ABSTRACT The purpose of this career development award is to provide the candidate with the training necessary to become an independent investigator 1) advancing scientific knowledge about how social and economic factors are shaping HIV risk and outcomes among marginalized, priority health disparity populations, and 2) designing effective interventions that reduce HIV prevalence and improve health and well-being within sexual and gender minority populations. Research Aims Transgender and nonbinary people experience significant economic hardships and disproportionately shoulder the burden of the HIV/AIDS epidemic in the United States. Guided by an integrated asset theory and social ecological framework, and using a multistage mixed methods approach, the candidate plans to conduct community-based paticipatory formative research necessary to inform the adaptation of an economic empowerment intervention to improve HIV prevention and care outcomes among transgender and nonbinary people who have sex with men (TGSM) in the U.S. First, the PI will establish a robust Community Collaborative Board (CCB) comprised of key members of the target populations. With the CCB and under the guidance of the mentorship team, the PI will finalize study design and protocol, informed by current pilot study findings. Next, the PI will undertake quantitative (surveys, N=390) and qualitative (interviews, n=36) research to achieve Aim 1: to estimate and qualitatively describe how co-occurring forms of economic hardship, defined as economic marginality, are associated with HIV outcomes among TGSM. Integrated Aim 1 findings and CCB guidance will inform study Aim 2: adaptation of an HIV economic empowerment intervention for economically marginalized TGSM in the U.S. After adapting the intervention, Aim 3 is: to assess acceptability and feasibility of the adapted intervention and generate preliminary data to inform an R01 application by pilot testing with 42 TGSM using a waitlist control design, then refining the intervention with the CCB. The proposed research builds from the infrastructure and community ties developed by Project AFFIRM (R01HD079603/ R01HL151559A1; PI: Bockting) in New York City, San Francisco, and Atlanta and furthers the NIH HIV strategic goal to “advance innovative research to identify and implement effective strategies to mitigate underlying HIV- associated medical and social inequalities that diminish the health and well-being of persons living with or at risk for HIV.”1,p.12 This research is designed to support the training goals of the PI. Training Goals To become an independent investigator, the candidate requires additional training in four core areas: community-based participatory research; asset theory; quantitative methods; and how to adapt, test, assess, and refine socio- behavioral interventions to improve HIV outcomes among key populations. Hosted by The HIV Center at Columbia University and New York State Psychiatric Institute, the candidate will engage in close mentorship, coursework, directed readings, workshops, workgroups, and hands-on research to achieve these training goals.