# Characterizing intersecting sexual, gender, and race-based stigmas affecting communities of US transgender women and cisgender men who are sexually active with men

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2021 · $822,549

## Abstract

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 tr...

## Key facts

- **NIH application ID:** 10403117
- **Project number:** 1R01NR020437-01
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Stefan David Baral
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $822,549
- **Award type:** 1
- **Project period:** 2021-09-22 → 2026-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10403117

## Citation

> US National Institutes of Health, RePORTER application 10403117, Characterizing intersecting sexual, gender, and race-based stigmas affecting communities of US transgender women and cisgender men who are sexually active with men (1R01NR020437-01). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10403117. Licensed CC0.

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