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 men who have sex with men (MSM) and transgender women in the Dominican Republic. To accomplish Aim 1, we will conduct qualitative in- depth interviews with healthcare workers who provide HIV care, focus groups with PLWH, 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 revised FRESH intervention to obtain estimates of its potential to reduce stigmatizing attitudes and behaviors from healthcare workers and experiences of stigma reported by sexual and gender minority clients (primary); and secondarily assess if revised FRESH improves medication and visit adherence. As part of Aim 3, we will translate English HIV and intersectional stigma scales into Spanish and test the Spanish scales’ reliability, assess the change in stigma measures and related constructs before and after the FRESH intervention from PLWH and healthcare workers, measure the direction of all effects, and examine HIV cascade outcomes pre- and post-intervention. We hypothesize that by reducing stigmas in healthcare workers -- through their participation in FRESH -- we will improve aggregated patient outcomes across the HIV continuum of care at our intervention site and as compared to the outcomes from our control site. 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...