# Impact of multiple stigmas on HIV care continuum outcomes for key populations

> **NIH NIH R21** · ALBERT EINSTEIN COLLEGE OF MEDICINE · 2020 · $218,479

## Abstract

Background: Globally, stigma continues to be a major barrier to engage and retain PLWH in care. The 
goal of this proposal is to understand the impact of multiple stigmas on antiretroviral (ART) 
initiation and retention in care among men who have sex with men (MSM) and transwomen (TW) living 
with HIV (MSM/TW+H) in India. India has the third largest HIV burden in the world, and the epidemic 
disproportionately impacts MSM/TW. Key (stigmatized) populations such as MSM/TW+H, are more likely 
to have poor HIV treatment outcomes, resulting in rates of ART initiation/retention and viral 
suppression that are unacceptably low to achieve UNAIDS 90-90- 90 goals. In India, MSM and TW 
women, though two distinct populations, face similar gender or sexual-identity and HIV-related 
stigmas, which may: (1) directly discourage HIV care engagement and (2) indirectly reduce capacity 
for HIV care engagement via mediators such as poor mental health (depression/anxiety), 
psychological resources (e.g. poor coping skills), and interpersonal factors (e.g. lack of social 
support).
Studying stigma and its mediational paths to HIV outcomes are needed.
Methods: This R21 study, responsive to PA 18-277,"studies designed in partnership with service 
providers ... to understand factors impacting ART initiation... retention," is an innovative 
collaborative community research partnership with India's largest community-based HIV service 
provider. It is designed to leverage the agency's robust service and tracking infrastructure to 
conduct a longitudinal prospective cohort study of stigma, associated clinical outcomes (ART 
initiation and retention at 6 months), and potential mediators in 370 MSM­-TW+H (185 MSM/TW each). 
Guided by the HIV Stigma Framework, our Aims are to: 1) Characterize the prevalence and change over 
time of multiple stigmas in a cohort of newly diagnosed Indian MSM/TW+H. This will also involve 
exploring potential differences in levels and types of stigmas between MSM and TW to inform future 
intervention development. 2) Examine the longitudinal direct and indirect (via mental health,  
interpersonal factors, and psychological resources) effects of stigmas on a) ART initiation by 3 
months and b) retention in ART care at 6 months. We will also explore differences in the magnitude 
of effects across different stigmas for each outcome to better understand which are the strongest 
targets for future interventions. We will additionally conduct exploratory analyses to a) examine 
differences in these effects for MSM versus TW; and
b) identify how future interventions can be tailored to meet the needs of each group.
Potential Impact. While global health agencies are calling to reduce HIV and MSM/TW stigma, no 
effective and scalable interventions exist that address multiple stigmas among MSM/TW+H to improve 
HIV care continuum outcomes. This study will provide the needed empirical data about the multiple 
stigmas faced by MSM/TW+H, these stigmas' influence ...

## Key facts

- **NIH application ID:** 9979953
- **Project number:** 5R21MH118102-02
- **Recipient organization:** ALBERT EINSTEIN COLLEGE OF MEDICINE
- **Principal Investigator:** Viraj V Patel
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $218,479
- **Award type:** 5
- **Project period:** 2019-07-17 → 2023-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9979953

## Citation

> US National Institutes of Health, RePORTER application 9979953, Impact of multiple stigmas on HIV care continuum outcomes for key populations (5R21MH118102-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9979953. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*