Reducing Stigma and HIV Risk Behaviors among Kathoey in Bangkok, Thailand

这项拟议的研究将审查艾滋病毒预防的可接受性、可行性和初步疗效 一项旨在减少跨性别者中的耻辱、变性和艾滋病毒风险行为的计划 泰国曼谷的KSW。据报告， 曼谷和泰国其他大城市。KSW从事物质使用和艾滋病毒风险行为， 暴露于独特的个人，文化和社会因素，使他们更容易感染艾滋病毒（例如， 性别认同和激素使用）。针对KSW的艾滋病毒预防研究存在巨大差距， 解决羞辱和变性恐惧症。PrEP在泰国通过指定医院提供， 示范项目;然而，很少有KSW参加PrEP。 预防干预课程基于我们以前针对美国变性妇女的项目，审查 的可接受性和可行性，并评估试点干预的初步效果。干预 将从经验支持的艾滋病毒预防干预中调整原则：动机增强 干预（MEI），并将为KSW制定文化上合适的创新艾滋病毒预防计划 (e.g.,通过手机和利用街头小贩进行招聘提供后续MEI会议）。的 研究小组由曼谷朱拉隆功大学和曼谷公共卫生研究所的研究人员组成。 美国，在KSW的艾滋病预防方面有丰富的经验，在目标人群中有很好的基础， 社区.本研究的具体目的是：1）调整艾滋病毒预防MEI方案，用于KSW， 我们将在与kathoey社区讨论的基础上进行形成性研究的迭代阶段。 咨询委员会（CAB）成员，当地专家和街头小贩，并修订议定书; 2）进一步完善 我们会招募16名义工，并进行初步可行性评估， 方案的可接受性，并进一步将反馈纳入方案; 3）探索初步效果 我们的适应MEI干预和检查试验实施程序，我们将随机分配120 KSW向MEI提供由经过培训的kathoey健康教育工作者（KHE）或健康促进信息- 只有对照组。我们将检验我们的主要假设，即接受MEI的参与者更有可能 减少耻辱，变性恐惧症，物质使用和性风险行为，并增加自尊，社会 支持，并在后续评估中登记PrEP与对照组相比。通过流程 评估，我们将检查干预的可接受性，可行性，保真度和试验的实施情况 程序;如招募、随机化和随访保留。拟议的研究将提供 为准备R 01申请以检查艾滋病毒预防干预措施的有效性奠定坚实的基础 该计划包括行为（MEI）和生物医学（PrEP）组件，目标是泰国的KSW， 艾滋病毒和药物滥用的高风险，但被泰国的艾滋病毒预防计划所忽视。

The proposed study will examine the acceptability, feasibility, and preliminary efficacy of an HIV prevention program aiming to reduce stigma, transpobia, and HIV risk behaviors among kathoey (transwomen) sex workers (KSWs) in Bangkok, Thailand. High HIV sero-prevalence has been reported among kathoey in Bangkok and other large cities in Thailand. KSWs engage in substance use and HIV risk behaviors and are exposed to unique individual, cultural, and social factors that elevate their vulnerability for HIV infection (e.g., gender identity and hormone use). There is a huge gap in HIV prevention studies targeting KSWs, particularly addressing stigma and transphobia. PrEP is available in Thailand through designated hospitals and demonstration projects; however, few KSWs have enrolled in PrEP. We propose to develop an HIV prevention intervention curriculum based on our previous projects targeting transwomen in the U.S., examine the acceptability and feasibility, and evaluate the preliminary efficacy of a pilot intervention. The intervention will adapt principles from an empirically supported HIV prevention intervention: Motivational Enhancement Intervention (MEI) and will develop culturally appropriate and innovative HIV prevention programs for KSWs (e.g., delivering follow-up MEI sessions through cellphone and utilizing street vendors for recruitment). The study team consists of researchers at Chulalongkorn University, Bangkok and the Public Health Institute in the U.S., and has ample experience in HIV prevention for KSWs and is well-grounded in the targeted kathoey communities. The specific aims of the study are: 1) To adapt HIV prevention MEI protocols for use with KSWs, we will conduct iterative phases of formative research based on discussions with the kathoey community advisory board (CAB) members, local experts, and street vendors, and revise the protocol; 2) To further refine the intervention protocol, we will recruit 16 KSWs and conduct a preliminary assessment of the feasibility and acceptability of the protocol and further integrate feedback into the protocol; 3) To explore preliminary effects of our adapted MEI intervention and examine trial implementation procedures, we will randomly assign 120 KSWs to either MEI delivered by trained kathoey health educators (KHEs) or a health promotion information- only control group. We will examine our primary hypothesis that participants receiving MEI are more likely to reduce stigma, transphobia, and substance use and sexual risk behaviors and increase self-esteem, social support, and enroll in PrEP at follow-up assessments compared with the control group. Through process evaluation, we will examine intervention acceptability, feasibility, fidelity, and implementation of the trial procedures; such as recruitment, randomization, and follow-up retention. The proposed study will provide a solid foundation for preparing an R01 application to examine the efficacy of the HIV prevention intervention program with behavioral (MEI) and biomedical (PrEP) components targeting KSWs in Thailand who are at high risk for HIV and substance abuse, but have been neglected by HIV prevention programs in Thailand.