# Reducing Intersectional Stigma among High-Risk Women in Brazil to Promote Uptake of HIV Testing and PrEP

> **NIH NIH R01** · UNIVERSITY OF CALIFORNIA, SAN FRANCISCO · 2020 · $670,468

## Abstract

PROJECT SUMMARY
Globally, transgender (`trans') women experience extreme social and economic marginalization due to
intersectional stigma, defined as the confluence of stigma that results from the intersection of social identities
and positions among those who are multiply oppressed. Among trans women, gender-based stigma intersects
with social positions such as engagement in sex work and substance use, as well as race-based stigma to
generate a social context of vulnerability and increased risk of HIV acquisition. In Brazil, trans women are the
`most-at-risk' group for HIV, with 55 times higher estimated odds of HIV infection than the general population;
further, uptake of HIV testing and pre-exposure prophylaxis (PrEP) among trans women is significantly lower
than other at-risk groups, despite availability in the public sector and documented interest in the community.
Through extensive formative work, we have developed a multi-level intervention utilizing HIV prevention
strategies which have demonstrated feasibility and acceptability by trans women in Brazil, to address
intersectional stigma and increase engagement of trans women in the HIV prevention continuum. We propose
to test `Guerreiras' (`warrior women', as named by trans women participants in Brazil), comprised of two
intervention components designed to address intersectional stigma: 1) a group-level, peer-led intervention and
2) an individual-level peer navigation program to increase uptake of HIV testing and PrEP. Guerreiras is
informed by a trans-specific conceptual model, gender affirmation theory, that describes intersectional stigma
faced by trans women, informs investigations of how intersectional stigma results in health disparities, and
provides a framework for intervention development and testing. We will recruit trans women (N=400) from
clinical sites, outreach events, and an observational cohort in São Paulo, Brazil. Guerreiras will be evaluated
using a randomized wait-list controlled trial to compare HIV testing uptake (self-testing and clinic-based) (Aim
1), PrEP initiation and persistence (Aim 2), and other prevention services (e.g. harm reduction) among trans
women in the intervention arm compared to those in the control arm with data collection scheduled every three
months. We will assess changes in intersectional stigma (Aim 3), including reductions in internalized stigma
and increased resilience to anticipated and enacted stigma, among those assigned to intervention compared to
those assigned to control, and assess how changes in stigma domains result in prevention uptake. Outcomes
will be monitored through the national medications dispensing system (PrEP initiation and persistence), clinical
records and self-report (HIV testing), and through comprehensive surveys (intersectional stigma). The
proposed research leverages a productive multi-disciplinary HIV research partnership with extensive
experience working with trans women in Brazil, multi-level intervention compon...

## Key facts

- **NIH application ID:** 9995595
- **Project number:** 5R01MH121308-02
- **Recipient organization:** UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
- **Principal Investigator:** Sheri Ann Lippman
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $670,468
- **Award type:** 5
- **Project period:** 2019-08-14 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9995595

## Citation

> US National Institutes of Health, RePORTER application 9995595, Reducing Intersectional Stigma among High-Risk Women in Brazil to Promote Uptake of HIV Testing and PrEP (5R01MH121308-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9995595. Licensed CC0.

---

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