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

项目摘要 拟议的研究涉及艾滋病毒感染者（PLWH）的高度耻辱化，特别是性别 多米尼加共和国艾滋病毒治疗系统中， 病人-提供者干预措施的调整和测试-找到尊重和消除艾滋病毒的污名 （新鲜）。多米尼加共和国是一个高度优先的国家，越来越需要减少艾滋病毒污名化 问题研究加勒比地区是世界上艾滋病毒感染率第二高的区域，但得到的援助不足。 艾滋病毒相关污名研究基金。多米尼加共和国是五个国家之一，占95%以上， 所有加勒比艾滋病毒感染;它也有一个显着的集中艾滋病毒流行，一个非常保守的社会 其中艾滋病毒携带者和艾滋病病毒携带者被污名化，全国病毒载量抑制率极低。完成 在本次试点研究中，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机构中经历的艾滋病毒相关和交叉污名 (MSM)和跨性别女性的问题。为了实现目标1，我们将进行定性研究- 与提供艾滋病护理的医护人员、艾滋病病毒感染者重点群体进行深入访谈， 采访跨性别女性。目的2是适应新鲜，以解决男男性接触者所经历的耻辱， 多米尼加共和国的跨性别女性我们将使用ADAPT-ITT框架应用目标1的发现 系统地调整FRESH，这是一种用于减少医疗保健环境中耻辱感的干预措施 在非洲和美国。通过一个迭代过程，FRESH的每一个修订版都将与 艾滋病毒携带者和卫生保健工作者征求和纳入他们对每个版本的适应 干预目标3将对修订后的FRESH干预措施进行试点测试，以估计其减少 医护人员的污名化态度和行为，以及性和 少数性别客户（主要）;其次评估修订后的FRESH是否改善了药物和访视 坚持。作为目标3的一部分，我们将把英文艾滋病毒和交叉污名量表翻译成西班牙文， 西班牙量表的信度，评估污名措施和相关结构的变化前后， PLWH和医护人员的FRESH干预，测量所有影响的方向，并检查 干预前后艾滋病毒级联结果。我们假设，通过减少医疗保健中的耻辱感， 工作人员-通过他们参与FRESH -我们将改善艾滋病毒患者的总体结果， 在我们的干预现场的连续护理，并与我们的控制网站的结果相比。通过调整 并在加勒比西班牙语地区测试FRESH干预措施，FRESH可能成为一个有效的， 多区域艾滋病毒和交叉污名减少干预措施，专为以下国家的医疗保健环境设计： 高耻辱，文化保守，资源有限的社区;这样的科学发展将是 这是对加勒比和全球减少艾滋病毒污名化努力的重大贡献。

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.