Engaging Vulnerable Women in HIV Prevention and Health Promotion through a Stigma-Reduction Intervention: A Pilot Study

PROJECT SUMMARY This collaborative project between Beijing Normal University, Brown University, and Emory University responds to PAR-23-190 by developing and testing a stigma reduction focused, gender affirmative mobile health (mHealth) program to engage Chinese transgender women (TW) in HIV prevention via promoting their mental and sexual

health, HIV self-testing and use of HIV and gender-related community and medical resources. Chinese TW are at threefold higher odds of HIV infection compared to their cisgender men who have sex with men peers yet no intervention or public health initiative exists to address their HIV prevention needs. Chinese TW also face multi-

levels gender minority stress in a high stigma societal context, which in turn adversely affects their behavioral health, awareness of services, and HIV service-seeking behaviors (e.g., testing), which ultimately contribute to heightened HIV risk. There is an urgent need for evidence-based gender affirmative program as a potential way

to engage TW in HIV prevention services and enhance their psychological and sexual health in high-stigma, LMIC contexts such as China. Building on the Gender Minority Stress framework and Transgender Resilience Intervention Model, and informed by our team’s prior work mHealth for HIV-related mental and behavioral health,

we propose to develop a mobile app-based intervention (entitled “Zhen Wo”/”True Self”) delivered by TW peer counselors, who will provide gender-affirmative counseling and skills training that aim to reduce internalized transphobia and sexual risk behaviors, enhance coping and mental health, self-advocacy skills and resource

utilization to combat multi-levels gender stigma and structural barriers, and promote engagement in HIV prevention services. By developing a low-cost, mHealth program delivered by TW peers and establishing a protocol that engages with existing community resources, the True Self program has the potential to achieve

scalability and sustainability, if proven to be efficacious. The aims of this early phase, clinical project include: (1) conduct formative interviews with Chinese TW (n = 25) and stakeholders (n = 10) to identify stigma-related factors at various levels that contribute to poor mental health, sexual risk, and HIV testing, coping strategies,

resources, and preferences for intervention content and delivery procedures; (2) develop the True Self program for Chinese TW at risk for HIV, followed by a small open pilot (n = 10) to finalize intervention protocol; (3) evaluate the feasibility, acceptability, safety, and preliminary effects of the True Self program via a randomized controlled

trial (RCT) with TW with recent condomless/PrEP-less sex (n = 60). We will conduct quantitative assessments at baseline, 3-month, and 6-months follow-ups. We will conduct exit-interviews with TW assigned to the True Self condition (n = 30) to identify areas for further improvement and understand barriers and facilitators of

engagement, along with interviews with stakeholders (n = 18) to inform future efficacy and implementation study designs. This developmental grant will provide essential data to guide subsequent R-series application for a fully- powered RCT and invest in capacity development for researchers and transgender health professionals in China.