HIV prevalence is disproportionately high among Male-to-female transgenders (Hijra) in India. Stigma among health care providers limits HIV testing, treatment and care and creates a barrier to HIV protective behavior. Stigmatization of transgender by healthcare providers has been documented, and is identified as a significant barrier to effective HIV prevention responses among this marginalized, at-risk population in India. However, evidence based interventions to reduce stigma and discrimination among health care providers are seriously lacking. The proposed project will address this need by developing a theory-based, culturally relevant stigma -reducing intervention targeting health care providers in Mumbai, India. The proposed multidisciplinary US-India collaborative research team with significant HIV/AIDS research experience will implement a two-year formative study (R21) to develop and pilot health-care provider-focused stigma reducing intervention. The study has three specific aims: 1) Document cause and manifestation of stigma among health care providers in Mumbai;2) Use the information to design a provider-focused intervention module, and obtain community feedback;3) Pilot the revised intervention module among 50 healthcare providers, and assess its feasibility, acceptability and preliminary effect on health service behavior among healthcare providers. These data will prepare the team to conduct a large scale randomized controlled trial in India.
Stigma among health care providers is a deterrent to HIV health care access among transgender population not only in India, but also across South East Asia. However, to date there have been very few evidence based stigma reducing interventions targeting health care providers. The proposed study involves development and piloting a cognitive-behavioral intervention for health care providers in Mumbai, the result from which will inform larger efficacy trial and future program development.