# Adapting the Finding Respect and Ending Stigma around HIV (FRESH) Intervention for the Dominican Republic

> **NIH NIH R21** · UNIVERSITY OF ALABAMA AT BIRMINGHAM · 2021 · $149,373

## Abstract

PROJECT SUMMARY
The proposed study addresses the high level of stigma against people living with HIV (PLWH), particularly gender
and sexual minorities, that is embedded in the Dominican Republic’s HIV treatment system through the
adaptation and testing of a patient-provider intervention -- Finding Respect and Ending Stigma around HIV
(FRESH). The Dominican Republic is a high priority setting with an increasing need for HIV stigma reduction
studies. The Caribbean holds the second highest regional burden of HIV in the world, yet receives insufficient
HIV-related stigma research funding. The Dominican Republic is 1 of 5 countries that accounts for over 95% of
all Caribbean HIV infections; it also has a significant concentrated HIV epidemic, a deeply conservative society
in which PLWH are stigmatized, and an exceptionally low national viral load suppression rate. To accomplish
this pilot study, three Specific Aims are proposed. Aim 1 is to explore sources, characteristics, and consequences
of HIV-related and intersectional stigmas experienced in healthcare settings by MSM and transgender women
to inform the adaptation of FRESH. To accomplish Aim 1, we will conduct qualitative in-depth interviews with
healthcare workers who provide HIV care, focus groups with MSM, and in-depth interviews with transgender
women. Aim 2 is to adapt FRESH to address stigmas experienced by MSM and transgender women in the
Dominican Republic. We will apply the Aim 1 findings using the ADAPT-ITT framework to systematically adapt
FRESH, an intervention that has been employed to reduce stigma in healthcare settings in Africa and the United
States. Through an iterative process, each revision of FRESH will be shared with both PLWH and healthcare
workers to solicit and incorporate their feedback about each version of the adapted intervention. Aim 3 will pilot-
test the adapted intervention to obtain estimates of its ability to reduce stigmatizing attitudes and behaviors from
HWs and experiences of stigma reported by sexual and gender minorities (SGM) and non-SGM clients living
with HIV (primary); while exploring if FRESH has the potential to influence clinic-level HIV cascade outcomes.
By adapting and testing the FRESH intervention for the Spanish-speaking Caribbean, FRESH could become a
validated, multi-region HIV and intersectional stigma reduction intervention designed specifically for healthcare
settings in high-stigma, culturally conservative, resource-constrained communities; such a scientific
development would be a significant contribution to HIV stigma reduction efforts in the Caribbean and globally.

## Key facts

- **NIH application ID:** 10220168
- **Project number:** 5R21TW011761-02
- **Recipient organization:** UNIVERSITY OF ALABAMA AT BIRMINGHAM
- **Principal Investigator:** Henna Budhwani
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $149,373
- **Award type:** 5
- **Project period:** 2020-08-01 → 2022-08-08

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10220168

## Citation

> US National Institutes of Health, RePORTER application 10220168, Adapting the Finding Respect and Ending Stigma around HIV (FRESH) Intervention for the Dominican Republic (5R21TW011761-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10220168. Licensed CC0.

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