Development of an Online Provider Intervention to Address Intersectional Stigma and Medical Mistrust in People Living with HIV - PROJECT SUMMARY/ABSTRACT
Intersectional stigma and discrimination are key contributors to health disparities, including in HIV care, in
Black and Latinx communities. As a result of historical and ongoing stigma and discrimination in the U.S.,
medical mistrust is highly prevalent in Black and Latinx communities, including those living with HIV, and
contributes to low care engagement, treatment nonadherence, and poor health outcomes. However, no
evidence-based provider intervention is available for providers to gain knowledge and skills to address
intersectional stigma and medical mistrust with patients. This study responds to the call in RFA-DA-21-001 to
“reduce the impact of intersectional stigma and strengthen the provision and utilization of HIV prevention or
care services,” by developing an intervention for HIV care providers working with individuals who experience
intersectional stigma and discrimination. The proposed intervention has the potential to improve providers’
competence to address the impact of intersectional stigma and medical mistrust with patients, which may in
turn improve patient’s healthcare engagement, treatment adherence, and health outcomes. Aim 1 involves
developing an online provider intervention for HIV care providers to gain knowledge and skills to address the
impact of experiencing intersectional stigma and discrimination, with particular focus on medical mistrust, using
input from key community stakeholders, including HIV providers and patients from Black and Latinx
communities. The intervention will include psychoeducation on the impact of intersectionality and medical
mistrust on patients as well as skills training to address these issues based on principles of motivational
interviewing (MI), cognitive behavior therapy (CBT), and the science of behavior change. We will engage
community stakeholders to provide feedback on the intervention content. The context of the intervention will be
online, and we will work with a provider training center partner to develop the online platform and conduct a
usability test in 10 HIV care physicians. Aim 2 involves conducting a pilot randomized controlled trial in 80
physicians providing care for patients at risk or living with HIV to test the intervention (n = 40) against a no-
treatment control group (n = 40). Provider training outcomes will include providers’ use of skills learned in the
intervention (e.g., MI-consistent statements) to address intersectional stigma and medical mistrust using
hypothetical patient scenarios, and provider-reported HIV service delivery outcomes. Outcomes will be
assessed at baseline, immediately post-intervention, and at 12-month follow-up. A mixed-method process
evaluation will be conducted at post-intervention to assess acceptability, feasibility, and appropriateness of the
online intervention. Results from this study have the potential to significantly advance scientific knowledge and
clinical practice regarding addressing intersectional stigma and medical mistrust at the provider-level with
patients from Black and Latinx communities as a way to reduce HIV-related disparities.
