Improving wellbeing, HIV prevention, and intersectional stigma among multiply marginalized Chinese women in NYC - PROJECT SUMMARY The proposed study aims to use a community-driven process to refine and pilot test a multi-level HIV prevention and wellness intervention designed to increase HIV testing by addressing intersectional stigma, focusing on Chinese immigrant female sex workers (FSWs) in New York City (NYC). This population is at significant risk for HIV but exhibits low HIV testing rates. Chinese immigrant FSWs face a convergence of multiple and intersecting stigmas and multiple structural vulnerabilities, which contributes to their low levels of HIV testing. Only a limited number of HIV interventions have explicitly targeted multi-level, intersectional stigma to increase HIV prevention behaviors, and none have specifically targeted Chinese immigrant FSWs and the providers who serve them. Accordingly, the proposed project (“Initiative for Chinese Sex workers to Promote wellbeing and Improve HIV prevention by Reducing intersEctional stigma” [INSPIRE]) aims to conduct a feasibility study of a culturally relevant, multi-level HIV prevention and wellness intervention designed to increase HIV testing through reducing intersectional stigma. The preliminary design of INSPIRE was developed based on the investigators’ extensive preliminary research with Chinese immigrant FSWs, principles of Social Action Theory, and elements of an existing evidence-based HIV prevention intervention for FSWs (Community Promise). To prepare INSPIRE for pilot-testing, we propose the following complementary components: 1. At the individual-level, use a community-driven process to further refine INSPIRE’s design and optimize it with intersectional stigma components; 2. At the institutional-level, incorporating key elements of stigma-reduction outlined by Nyblade and colleagues, develop an anti-stigma training for providers to create a welcoming environment for FSWs who, encouraged by the individual-level component, decide to seek out the health services they need. The Specific Aims of INSPIRE are to: Aim 1: Using the ADAPT-ITT model, refine and stigma-optimize INSPIRE, a multi-level culturally relevant HIV prevention and wellness intervention for Chinese immigrant FSWs designed to increase HIV testing by addressing individual-level (internalized) and institutional-level (healthcare providers) intersectional stigma; Aim 2: Conduct a pilot randomized controlled trial of INSPIRE to gather necessary information for developing a full-scale trial; Aim 3: Systematically assess the feasibility, acceptability, and barriers to/facilitators of implementing INSPIRE using mixed methods and guided by the intersectionality-enhanced CFIR. By developing and testing an innovative, culturally relevant HIV testing intervention that addresses intersectional stigma, the proposed study will make substantial contributions to reducing HIV risk in this highly vulnerable, under-served, and under-researched population.
