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

7.项目摘要-摘要 拉丁美洲在过去十年中没有实现艾滋病毒新病例的任何减少。在厄瓜多尔， 女性-那些认为自己是女性或跨女性的人， 与顺性别男性发生性关系的新生儿是艾滋病毒流行的关键人群。厄瓜多尔的艾滋病毒流行率 在跨性别女性中，这一比例在20.7%-34.8%之间，是拉丁美洲最高的。研究迫切 需要指导艾滋病毒预防和护理工作，以遏制艾滋病毒感染率。多重边缘化人群 身份，如生活贫困的非洲裔变性妇女，更有可能受到歧视， 交叉歧视比一般美国人口和艾滋病毒感染率高。然而， 厄瓜多尔跨性别妇女受到交叉歧视的负担， 与艾滋病毒预防和护理结果之间的联系仍不清楚。K 01奖将为候选人提供 在交叉定性，定量，干预发展和赠款写作，以解决培训 厄瓜多尔跨性别妇女面临交叉歧视和艾滋病毒负担的挑战。拟议 研究将评估交叉歧视对与性别平等的联系产生影响的机制， 厄瓜多尔变性妇女的艾滋病毒预防和护理，同时扩大和深化候选人的 研究技能。在研究目标1中，候选人将评估交叉歧视的经历（例如， 艾滋病毒污名化、种族主义、阶级歧视）与艾滋病毒预防和护理的关系， 变性妇女（培训目标1：将交叉性应用于定性方法）。在研究目标2中， 候选人将进行一项调查，以描述和纵向测试连接交叉点的路径， 与艾滋病毒预防和护理联系的结果（培训目标2： 流行病学方法和纵向定量研究设计）。在研究目标3中，候选人将 实施系统性ADAPT-ITT模型的前六个阶段，以调整艾滋病毒干预措施， 变性妇女（培训目标3：发展干预技能）。本研究和培训的结果 我将安排候选人制定R 01提案，以实施ADAPT-ITT模型的剩余步骤 并进行一项干预的随机对照试验（培训目标4：撰写拨款）。作为厄瓜多尔人 非二元酷儿美国移民研究员，候选人具有文化和研究背景， 利用这一拟议的K 01过渡到职业独立，并解决关键知识和干预问题 厄瓜多尔艾滋病毒预防和护理方面的差距。

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.