Transgender women have some of the highest rates of HIV in the world and are the highest HIV risk group in the United States and Brazil. Transgender women experience multiple stigmas that complicate their access to and adherence to healthcare, resulting in intersectional stigma and negative health outcomes. Intersectionality is a critical theory which posits that power relations construct our perspectives and experiences and has the potential to meaningfully inform research with transgender communities as well as an approach to mentorship across differences. Using novel applications of the framework of intersectionality, Dr. Jae Sevelius, Associate Professor in Residence, University of California, San Francisco, proposes (1) a plan for their own career development that will expand their research to include substance use and implementation science, (2) a plan to expand their program of research to provide ample training opportunities for mentees, and (3) a plan to provide mentoring focused on supporting mentees who are underrepresented in medicine (URM) and/or are launching a program of research focused on addressing health disparities among sexual and gender minorities (SGM). Their community-based, patient-oriented research is focused on the investigation of risk and protective factors in transgender communities and the relationship between stigma, discrimination, and health-related behaviors and outcomes. Dr. Sevelius' efforts have been dedicated to developing, implementing, and evaluating health promotion interventions that decrease health risks, including HIV transmission and acquisition, and improve treatment through behavioral changes, community programming, and increased access to culturally appropriate health care. Their research and scientific contribution of the trans-specific Model of Gender Affirmation is recognized nationally and internationally in the field of transgender health and HIV prevention and treatment. Mentee training will leverage the infrastructure and resources of Dr. Sevelius' ongoing intervention research and their collaborations with multidisciplinary and international researchers in the areas of HIV, substance use, and transgender health domestically and in Brazil. In order to expand the scope of their mentoring program, they propose to launch a group-based distance mentoring program, conduct facilitated writing intensives with their mentees, and produce scholarship and training in the area of intersectional mentoring. Lastly, Dr. Sevelius proposes to conduct K24 supported research studies that will serve as training vehicles for mentees and develop their research by (1) expanding their research experience and scholarship to include the characterization of substance use among transgender women within the context of HIV treatment, (2) cultivating expertise in implementation science to identify best practices for implementation of efficacious HIV prevention interventions among transgender populations who use substances, and (3) gaining experience assessing and contextualizing intersectional stigma among transgender populations in Brazil.
The overall aim of Dr. Jae Sevelius' K24 application is to develop and implement intersectional approaches to mentoring and patient-oriented research focused on HIV prevention and treatment interventions with transgender and gender diverse people who use substances. The specific aims of the research strategy are as follows: (1) to characterize the relationships between experiences of transgender-related discrimination, substance use, and engagement in HIV care among transgender women living with HIV, (2) to assess how implementation of an existing intervention for transgender women living with HIV is impacted by substance use among participants, and (3) to develop a contextually grounded understanding of multi-level intersectional stigma, including substance use stigma, among transgender women in Brazil to inform measurement refinement and future intervention strategies. Dr. Sevelius' specific focus on developing an intersectional approach to mentoring in patient-oriented research on substance use and HIV has the potential to directly contribute to increasing the pipeline of diverse researchers entering the field who have the capacity to develop and advance innovative approaches to major challenges in HIV prevention and substance use research.