R01NR020437

Characterizing Intersecting Sexual, Gender, and Race-Based Stigmas Affecting Communities of US Transgender Women and Cisgender Men Who Are Sexually Active with Men

The goal of this study is to characterize intersectional stigma related to gender identity, sexual behaviors, sexual orientation, race, and poverty, as a social determinant of HIV-related health among sexual and gender minorities (SGM) in the US. This proposal was developed in response to NIH's Notice of Special Interest (NOSI) to focus on understanding the role of intersectional stigmas and how they harm health.

A high prevalence of mental, physical, and sexual health problems has consistently been documented among SGM, including sexually transmitted infections (STIs), depression, and substance use. While stigma is understood to affect these outcomes, there is limited consensus on optimal intersectional stigma measurement strategies for both transgender women (TW) and cisgender men who have sex with men (CIS-MSM) or on the mechanisms by which intersecting stigmas drive health disparities, including those modifiable through health and behavioral interventions.

Our investigative team has an active NIMH-funded R01 (R01MH110358) focused on measuring stigma related to sexual behavior and examining how this stigma drives disparities in HIV outcomes for CIS-MSM using data from around the world, including from the American Men's Internet Survey (AMIS) in the US. In addition, we developed and piloted the Transgender Women's Internet Survey and Testing (TWIST) platform, demonstrating high burdens of anticipated, perceived, and enacted stigmas related to gender identity and their association with decreased use of HIV prevention services, greater psychological stress, and suicidal ideation among TW in the US.

Here, we propose to collect data on trends in stigma and health in two cross-sectional online surveys of sexually active TW (N=3,000 in years 2,4) and three of CIS-MSM (N=10,000 in years 1,3,5) accompanied by testing of self-collected biospecimens from 500 TWIST participants and 500 AMIS participants per survey (N=2,500 total). Consistent with NIH's NOT-MH-20-020, we will build upon our prior foundational work to better assess intersectional stigma and its HIV and other health impacts for TW and CIS-MSM in the US using a mixed-methods, transformative study designed to meet the following aims.

Aim 1: Optimize metrics of intersectional stigma experienced by diverse transgender women and cisgender men who have sex with men sampled online in the US.

Aim 2: Qualitatively explore perspectives of transgender women and cisgender men who have sex with men (MSM) of how intersecting stigmas shape engagement in HIV prevention and treatment services.

Aim 3A: Characterize cross-sectional relationships between intersectional stigmas and engagement in HIV prevention/treatment and gender affirmative care among national samples of TW and CIS-MSM in the US.

Aim 3B: Determine demographic, geographic, and temporal heterogeneities in the burden of intersectional stigmas and associations with sexual health, mental health and resilience, and engagement in HIV prevention and treatment in follow-up cross-sectional nationwide surveys of TW and CIS-MSM.

The Johns Hopkins University

NURSES UNDERSTAND THAT IMPROVING HEALTH AND WELL-BEING MEANS ADDRESSING PEOPLE'S NEEDS IN MULTIPLE SETTINGS, CONTEXTS, AND OVER THE WHOLE LIFE COURSE. SCIENCE SUPPORTED BY THE NATIONAL INSTITUTE OF NURSING RESEARCH (NINR) USES THIS HOLISTIC PERSPECTIVE TO IMPROVE INDIVIDUAL AND POPULATION HEALTH AND ADVANCE HEALTH EQUITY. NINR-SUPPORTED RESEARCH PROMOTES HEALTH AND WELL-BEING BY ADDRESSING NEEDS AT MULTIPLE LEVELS INDIVIDUAL, FAMILY, COMMUNITY, AND SOCIETAL LEVELS AND DEVELOPING TREATMENT AND PREVENTION STRATEGIES THAT ARE RESPONSIVE TO THE REALITY OF PEOPLE'S LIVES. NURSES KNOW PEOPLE, AND PEOPLE TRUST NURSES. PATIENT AND FAMILIES INTERACT WITH NURSES MORE THAN ANY OTHER CLINICIANS. NURSING SCIENCE USES THIS SPECIAL RELATIONSHIP TO BETTER UNDERSTAND PATIENTS, FAMILIES, AND COMMUNITIES AND THE MANY FACTORS THAT INFLUENCE THEIR HEALTH. NURSING SCIENCE SUPPORTED BY NINR USES THIS KNOWLEDGE TO DEVELOP STRATEGIES FOR IMPROVING HEALTH AND WELLNESS ACROSS POPULATIONS, HEALTH CARE SETTINGS, AND THE LIFESPAN, WITH AN EMPHASIS ON ACHIEVING HEALTH EQUITY. NINR-SUPPORTED SCIENTISTS HAVE DEVELOPED INTERVENTIONS FOR: SUPPORTING PARENTS OF PREMATURE INFANTS, PROMOTING HIV PREVENTION IN UNDERSERVED POPULATIONS, IMPROVING TRANSITIONAL CARE LEADING TO BETTER OUTCOMES AND COST-SAVINGS, AND HELPING INNER-CITY CHILDREN MANAGE ASTHMA. NURSING SCIENCE TRANSCENDS THE BOUNDARIES OF DISEASE AND RESEARCH DISCIPLINES TO BETTER UNDERSTAND THE EXPERIENCES OF INDIVIDUALS AND FAMILIES LIVING WITH ILLNESS AND TO DEVELOP PERSONALIZED APPROACHES THAT MAXIMIZE HEALTH AND WELL-BEING FOR INDIVIDUALS AT ALL STAGES OF LIFE, ACROSS DIVERSE POPULATIONS AND SETTINGS. NINR-SUPPORTED SCIENCE USES NURSING SCIENCE'S UNIQUE, PATIENT AND COMMUNITY-FOCUSED PERSPECTIVE AND WIDE REACH ACROSS CLINICAL AND COMMUNITY SETTINGS TO ADVANCE OUR UNDERSTANDING OF THE SOCIAL DETERMINANTS OF HEALTH: THOSE FACTORS THAT ARE AT THE ROOT OF THE INEQUITIES THAT WE SEE, SUCH AS FOOD INSECURITY AND ACCESS TO HEALTHCARE. NINR RESEARCH EFFORTS IN WELLNESS INVESTIGATE THE KEY BIOLOGICAL, BEHAVIORAL, AND SOCIAL FACTORS THAT PROMOTE LONG-TERM HEALTH AND HEALTHY BEHAVIORS AND PREVENT THE DEVELOPMENT OF ILLNESS ACROSS HEALTH CONDITIONS, SETTINGS, AND THE LIFESPAN. RESEARCH IN WELLNESS IS ALSO FOCUSED ON DEVELOPING AND TESTING CULTURALLY APPROPRIATE INTERVENTIONS TO PROMOTE HEALTH AND PREVENT ILLNESS IN MINORITY AND UNDERSERVED GROUPS. NINR ALSO SUPPORTS SCIENCE TO ASSIST INDIVIDUALS, FAMILIES, AND HEALTH CARE PROFESSIONALS IN MANAGING ADVANCED, SERIOUS ILLNESS, AND PLANNING FOR END-OF-LIFE DECISIONS. IN ADDITION, NINR PROMOTES TECHNOLOGICAL ADVANCEMENTS THAT ADDRESS A RANGE OF HEALTH CARE CHALLENGES AND FACILITATE THE DELIVERY OF REAL-TIME PERSONALIZED INFORMATION TO INDIVIDUALS AND FAMILIES, HEALTH CARE PROVIDERS, AND COMMUNITIES. FINALLY, NINR HAS A LONGSTANDING AND CONTINUING COMMITMENT TO DEVELOPING THE NEXT GENERATION OF NURSE SCIENTISTS: THOSE INDIVIDUALS AND TEAM MEMBERS WHO WILL CARRY THE FIELD OF NURSING SCIENCE INTO THE FUTURE. IN ORDER TO PREPARE AN INNOVATIVE, DIVERSE, AND TALENTED NEXT GENERATION OF NURSE SCIENTISTS, NINR SUPPORTS A VARIETY OF TRAINING OPPORTUNITIES FOR SCIENTISTS AND TRAINEES AT ALL CAREER LEVELS, PARTICULARLY THOSE AT AN EARLY CAREER STAGE WHO ARE SO CRITICAL TO SUSTAINING THE FUTURE OF INNOVATIVE RESEARCH AND HIGH QUALITY HEALTH CARE.

93.361 - Nursing Research

National Institute of Nursing Research (NINR) [HHS - NIH]

Maryland United States

State-Wide

Innovations in HIV Prevention, Testing, Adherence and Retention to Optimize HIV Prevention and Care Continuum Outcomes (R01 Clinical Trial Optional) (PA-20-144)

Termination This project grant was reported as terminated by the Department of Government Efficiency (DOGE) in July 2025. See All
Amendment Since initial award the End Date has been shortened from 06/30/26 to 03/21/25 and the total obligations have increased 271% from $684,972 to $2,540,940.