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

这项拟议的研究将检查艾滋病毒预防的可接受性、可行性和初步效果。 旨在减少kathoey(变性女性)性行为中的污名、易位恐惧症和艾滋病毒危险行为的计划 泰国曼谷的工人(KSWS)。据报道，在#年卡索伊中艾滋病毒血清流行率很高。 曼谷和泰国的其他大城市。KSWS从事药物使用和艾滋病毒危险行为，并 暴露于独特的个人、文化和社会因素，这些因素会增加他们感染艾滋病毒的脆弱性(例如， 性别认同和激素使用)。针对KSWS的艾滋病毒预防研究存在巨大差距，尤其是 解决污名和跨性别恐惧症。Prep在泰国通过指定的医院和 示范项目；然而，参加减贫战略方案的KSWs很少。我们建议开发一种艾滋病病毒 基于我们之前针对美国跨性别妇女的项目的预防干预课程，请查看 可接受性和可行性，并评价试点干预的初步效果。干预措施 将采用来自经验支持的艾滋病毒预防干预的原则：激励增强 干预(MEI)，并将为KSWS制定适合文化和创新的艾滋病毒预防方案 (例如，通过手机提供后续的Mei课程，并利用街头小贩进行招聘)。这个 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。 在KSWS的艾滋病毒预防方面有丰富的经验，并在目标Kathoey方面有很好的基础 社区。这项研究的具体目的是：1)使预防艾滋病毒的MEI方案适用于KSWS， 我们将根据与Kathoey社区的讨论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，并修改协议；2)进一步完善 在干预方案中，我们将招募16名KSWS，并对可行性和 协议的可接受性，并进一步将反馈整合到协议中；3)探索初步效果 对于我们适应的梅干预和审查试行程序，我们将随机分配120 由训练有素的Kathoey健康教育者(KHEs)向Mei提供的KSWS或健康促进信息- 仅为对照组。我们将检验我们的主要假设，即接受MEI的参与者更有可能 减少污名、跨性别恐惧症、物质使用和性危险行为，增加自尊、社交 支持，并与对照组相比，在后续评估中登记参加PrEP。直通流程 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、随机化和后续保留。拟议的研究将提供一个 为准备检查艾滋病毒预防干预效果的R01应用程序奠定了坚实的基础 针对泰国KSWS的具有行为(MEI)和生物医学(PrEP)组件的计划 艾滋病毒和药物滥用的高风险，但在泰国的艾滋病毒预防计划中被忽视。

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.