Kabawil: Adapting an Intervention to Reduce Intersectional Stigmas among Indigenous Sexual Minority Men and Traditional Healers in Mesoamerica

SUMMARY/ABSTRACT During the past decade in Latin America, new yearly HIV infections rose 21%, and as of 2022, HIV infections were still rising. Of the 3.8 million people living with HIV in the Americas, 2.8 million live in Latin America. The HIV epidemic continues to be highly concentrated among gay, bisexual, and other men who have sex with men

(GBM), especially in Mesoamerican countries such as Guatemala (9%), Belize (13.9%), Mexico (14.9%) and El Salvador (16.3%). Research points to multiple co-occurring psychosocial and structural conditions, including HIV- and sexuality-related stigmas that act as intertwined forces that potentiate HIV transmission among GBM.

This study addresses intersectional stigmas experienced by Indigenous GBM (IGBM) in Guatemala. This study will adapt a patient-provider stigma-reduction intervention - Finding Respect and Ending Stigma around HIV (FRESH). FRESH is workshop-based intervention that has been employed to reduce stigmas among healthcare

workers and GBM around the world, including a recent Spanish-language version in the Dominican Republic. Guatemala is a diverse society in which close to 50% of the population identifies as Indigenous. Indigenous Guatemalans who also identify as GBM, experience intersectional stigmas, including racial discrimination, which

increase vulnerability to HIV. Due to a crumbling public health system, and discrimination towards Indigenous people at public hospitals, Indigenous traditional healers (ITH) are the first line of response to those seeking health services. The adapted FRESH intervention, named KABAWIL in Maya K’iche language will be

implemented with IGBM and will include, for the first time, ITH. Our aims include: Aim 1: We will use the ADAPT- ITT framework to adapt FRESH and produce the culturally tailored KABAWIL intervention. We will conduct in- depth interviews (20 per group) and two focus groups with IGBM and ITH. Aim 2: We will use a randomized wait-

list control trial design to pilot test the intervention with 120 participants. Thirty IGBM and 30 ITH will be randomly assigned to three KABAWIL intervention workshops (10 GBM + 10 ITH per workshop; n=60). The other 30 GBM and 30 ITH will be assigned to the 3-month wait-list control. We will assess the intervention’s preliminary efficacy

on increasing HIV testing, PrEP uptake, PrEP/ART adherence, and decreasing experiences of stigma and discrimination. Aim 3: Evaluate facilitators and barriers to the implementation of the KABAWIL intervention. We will conduct a post-implementation, mixed-methods assessment guided by the Consolidated Framework for

Implementation Research (CFIR). We will conduct interviews with IGBM (n=10), ITH (n=10), and interventionists (n=10) to identify contextual and organizational factors that may impact the feasibility and acceptability of the intervention, and determine organizational/contextual fit for the design of a larger hybrid effectiveness

implementation trial to establish KABAWIL as a model for reducing intersectional stigmas and improve HIV prevention and care for indigenous people throughout the Americas.