Adapting an Intervention to Reduce Stigma among MSM and Healthcare Providers in Vietnam - Abstract Despite advancements in HIV prevention and treatment and the expansion of services, HIV prevalence among men who have sex with men (MSM) in Vietnam has risen dramatically, from 6.6% in 2015 to 12.5% in 2023. Persistent stigmatization of MSM as social evils, exacerbated by government campaigns associating MSM with the spread of HIV during the early period of HIV epidemic in Vietnam and reinforced by collectivist cultural norms against homosexuality, has exacerbated intersectional stigmas among MSM in Vietnam. This has led to discrimination, fear of disclosure, and avoidance of healthcare services, severely limiting MSM's access to HIV prevention and care services. To address these challenges, this study will culturally adapt a patient-provider stigma-reduction intervention-Finding Respect and Ending Stigma around HIV (FRESH) intervention- into DONGHANH ( meaning “companionship, understanding, and mutual support in Vietnamese), for implementation among Vietnamese MSM (the patients) and healthcare providers (HCP- the providers). FRESH is a workshop-based intervention that has been successfully used to reduce stigma among healthcare workers and marginalized populations, including MSM, globally. Toward the end of the DONGHANH intervention, participants are expected to work together to develop stigma reduction strategies that they can take back to their respective communities, thus increasing the impact of the intervention. The intervention will also involve the creation of an e-module (a website), allowing participants to determine its delivery and engage in ongoing learning at their convenience. The study will be conducted in three phases: Phase I: using the ADAPT-ITT framework, we will adapt FRESH intervention based on findings from in-depth interviews and focus group discussions to create the culturally tailored DONGHANH intervention. Phase II: We will use a randomized wait-list control trial design to pilot test DONGHANH intervention among 180 participants (MSM=120; HCP=60). Ninety participants (MSM=60, HCPs=30) will participate in the intervention, while the remaining 90 participants (MSM=60, HCPs=30) will be assigned to the 3-month wait-list control. We will assess the intervention’s feasibility, acceptability, and fidelity as well as assess the preliminary efficacy of the intervention on reducing experiences of intersectional stigma and discrimination, increasing HIV testing, PrEP uptake and PrEP/ART adherence. Phase III: We will evaluate assess facilitators and barriers to implementation through interviews with MSM, HCP and project intervention staff, using the Consolidated Framework for Implementation Research to identify contextual factors of the intervention for future scale-up. If the DONGHANH intervention is successful, it can provide a scalable model for reducing intersectional stigmas and improve HIV prevention and care among MSM in Vietnam and other low-and middle- income countries.
