Jamaica CARES Project: Connecting HIV/AIDS Resources to Engage Jamaican Sexual and Gender Minorities - PROJECT SUMMARY/ABSTRACT
Jamaica’s HIV/AIDS epidemic among sexual and gender minorities is the most severe in the Caribbean in
terms of its breadth and consequences. HIV prevalence among men who have sex with men is estimated at
33% and 51% among transgender women, which is significantly higher than the 1.8% observe in the general
population. Intersectional stigma (often related to intersecting identities) and violence are key drivers of poor
mental health and HIV care engagement, leading to higher rates of depression, anxiety, and low viral
suppression (21%). The goals of the proposed research are to 1) gain and understanding of the influences and
mechanisms by which intersectional stigma and violence impact mental health and engagement in HIV care;
and 2) refine our conceptual framework to aid in intervention development that assists sexual and gender
minorities to engage in HIV care. Candidate: I am a nurse-scientist with a background in health behavior
change theory and social determinants of health in the context of HIV. I am applying for a K23 Career
Development Award to obtain training, mentorship, and research experience to become an expert and
independent investigator in theory-based, behavioral intervention design to improve the health of sexual and
gender minorities in the Caribbean and in other low-resource settings. Mentoring: I have put together an
exceptional mentoring team with extensive experience in intersectional stigma measurement research, mental
health, and HIV treatment and prevention in resource-limited settings like Jamaica. Drs. Sheri Weiser and
Carol Dawson-Rose will serve as co-Primary mentors and bring complementary expertise in HIV treatment and
prevention, trauma, conceptual model framework refinement, and development and implementation of
behavioral interventions in resource-limited settings. My co-mentors, scientific advisor, and collaborator round
out my team to bring specific content and methods expertise and are based both in the United States and
Jamaica, including: Dr. Mallory Johnson (clinical psychologist, intervention design and evaluation; feasibility
implementation, ART adherence); Dr. Tor Neilands (psychology, quantitative methods, design and analysis of
longitudinal data); Dr. Sharlene Jarrett (clinical psychologist, mental health and HIV treatment in the Jamaican
context); Carmen Logie (clinical social worker, intersectionality and mixed methods research); Dr. Jae Sevelius
(clinical psychologist, intersectional stigma measurements, cognitive interviewing, and gender affirmation); Dr.
Anita Stewart (psychologist, measurement adaptation and testing expert); and Dr. Mark Padilla (medical
anthropologist, Caribbean sexualities researcher). Training: I propose to obtain training in acquiring
foundational knowledge in measures of intersectional stigma (adaptation and testing), advanced quantitative
training to collect and analysis skills, and to attain expertise in developing, piloting, and evaluating HIV
behavioral interventions. Training will be achieved through mentoring meetings, coursework, workshops,
mentored direct readings and primary research in Jamaica. Research: The goals of the proposed research are
to 1) identify the pathways between intersectional stigma, violence, mental health and HIV care engagement
among Jamaican sexual and gender minorities living with HIV; 2) develop and manualize a multi-level
intervention that addresses intersectional stigma, violence, and poor mental health in order to optimize HIV
care engagement among Jamaican sexual and gender minorities living with HIV; and 3) pilot test the multi-
level intervention for acceptability and feasibility among sexual and gender minorities living with HIV and their
healthcare provider. We will plan for a full-scale testing of the intervention in a planned R01 submission in year
5. Summary: The recently announced Ending the HIV Epidemic (EtHE) by the DHHS and under Sustainable
Development Goal 3 of the United Nations Program on HIV/AIDS highlight the pressing need for research to
address disparities among SGM and other key populations in the quest to halt HIV infections globally by 2030.
The proposed research and training activities will position me to conduct innovative, high-impact research to
address intersectional stigma, violence and mental health among SGM living with HIV in low-resource settings
to improve HIV treatment engagement.
