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

> **NIH NIH R21** · FLORIDA STATE UNIVERSITY · 2021 · $18,915

## 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 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...

## Key facts

- **NIH application ID:** 10708548
- **Project number:** 7R21TW011761-03
- **Recipient organization:** FLORIDA STATE UNIVERSITY
- **Principal Investigator:** Henna Budhwani
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $18,915
- **Award type:** 7
- **Project period:** 2020-08-01 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10708548

## Citation

> US National Institutes of Health, RePORTER application 10708548, Adapting the Finding Respect and Ending Stigma around HIV (FRESH) Intervention for the Dominican Republic (7R21TW011761-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10708548. Licensed CC0.

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