# Standardized Patients to Measure and Address Intersectional Stigma: An HIV Prevention Engagement Strategy

> **NIH NIH R34** · UNIVERSITY OF MINNESOTA · 2021 · $212,049

## Abstract

The 2018 World AIDS Day theme, “Know your Status,” highlighted global concern over lack of progress in HIV
testing uptake. Nearly a quarter of people living with HIV remain untested, depriving them of opportunities to
enter into the HIV prevention continuum and access to proven prevention tools like preexposure prophylaxis.
Consistent data highlight the role of HIV-related stigma as a barrier to accessing prevention services. This
barrier can be even more pronounced for individuals facing additional discrimination on account of behaviors
considered societal taboos such as same sex practices. Such intersectional stigma, or the juncture of multiple
stigmatized identities, can reinforce HIV prevention barriers by discouraging individuals from HIV testing for
fear it will associate them with other taboo behaviors or by lowering the quality of healthcare received from
providers who assume that all members of a certain key population have HIV. Disentangling the layered nature
of HIV stigma to inform a better understanding of its complexity is critical to developing comprehensively
effective stigma interventions. We propose a standardized patient (SP) approach to obtain an improved
measure of enacted healthcare stigma and inform design of a stigma intervention to improve behaviors of
healthcare providers and increase practice-level HIV test uptake. SPs are actors hired from the local
community and trained to present standardized, unannounced disease cases in area clinics for the purposes of
evaluation and feedback. Their ability to objectively document provider behaviors through unannounced visits
presents an elegant solution to the classic challenges of stigma measurement: low provider willingness to self-
report discriminatory behaviors and the common tendency to alter one’s behaviors under observation. We will
dispatch SPs using an experimental audit approach that varies the sexual orientation and HIV status of
presented cases in order to obtain discrete measures of HIV, sexual, and intersectional stigma. A return of
these stigma results (RoR) with local providers and MSM will then be used to solicit their views on stigma
drivers and to inform design of a tailored stigma reduction intervention. We hypothesize that an intervention
incorporating the feedback of those closest to the problem—providers and MSM—will more effectively reduce
HIV, sexual, and intersectional stigma and increase practice-level HIV test provision, relative to a standard of
care. Our interdisciplinary team combines expertise in HIV prevention, LGBT health, HIV stigma, standardized
patient research, and medical education to investigate the following aims: 1) develop an experimental audit to
conduct baseline assessment of sexual, HIV, and intersectional stigma in STD practices; 2) conduct a RoR of
the experimental audit to solicit input from providers and MSM on the stigma intervention; and 3) conduct a
pilot cluster randomized control trial (RCT) to assess feasibility, acceptabili...

## Key facts

- **NIH application ID:** 10196975
- **Project number:** 5R34MH121251-03
- **Recipient organization:** UNIVERSITY OF MINNESOTA
- **Principal Investigator:** M Kumi Smith
- **Activity code:** R34 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $212,049
- **Award type:** 5
- **Project period:** 2019-09-01 → 2024-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10196975

## Citation

> US National Institutes of Health, RePORTER application 10196975, Standardized Patients to Measure and Address Intersectional Stigma: An HIV Prevention Engagement Strategy (5R34MH121251-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10196975. Licensed CC0.

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