We are Warriors: Promoting Awareness to Increase Options: A Communication Plan to Increase Awareness of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) and Comprehensive Healthcare to African-American Transgender Females Open Access

Stanley, Marcus (Fall 2019)

Permanent URL: https://etd.library.emory.edu/concern/etds/tb09j6852?locale=en


In the United States, more than one million people are living with HIV, with an estimated 15% unaware of their status (CDC, 2017). According to the most recent CDC data reported from the over 3 million testing events around the United States, the percentage of new HIV diagnoses for transgender people was three times the national average (CDC, 2018a). Despite the increased risk of HIV among transgender women, transgender people are still not designated as a priority population for PrEP by the CDC, which prioritizes sexually active men who have sex with men (MSM), heterosexuals at substantial risk for HIV, and injection drug users CDC, 2018b). Higher HIV infection rates were found among African-American transgender females regardless of assessment method, and large percentages of transgender females reported engaging in risky behaviors (e.g., unprotected receptive anal intercourse, multiple casual partners, sex work) (Herbst et al., 2008). Contextual factors potentially related to increased HIV risk include mental health concerns, physical abuse, social isolation, economic marginalization, and unmet transgender-specific healthcare needs (Herbst et al., 2008).

The overarching aim of the “We are Warriors: Promoting Awareness to Increase Options” communication campaign is to increase access and awareness of comprehensive healthcare and resources, including access to Pre-exposure prophylaxis (PrEP) and Post-exposure prophylaxis (P.E.P.) for African American Male-to-Female transgender women in a comprehensive approach to transgender healthcare and to persuade the audiences to facilitate change in attitudes and behaviors in the CDC-defined South. Other potential stakeholders include medical professionals and healthcare practitioners, reproductive health organizations, researchers, and policymakers. The sub-goals of this campaign are to: (1) inform target audiences of risk factors related to lack of awareness and knowledge of African-American transgender females healthcare needs and how these factors may affect them personally, and (2) persuade in order to facilitate change in attitudes and behaviors, to not only recognize possible contributing factors but also to be proactive in health care and treatment.

Table of Contents

Chapter I: Introduction 1

Introduction and Rationale 1

Problem Statement 2

Purpose Statement 2

Project Addressed 2

Significance Statement 2

Chapter II: Review of the Literature 4

Barrier for Access to Care 5

Employment Discrimination 5

Healthcare Practitioner Stigma and Discrimination 6

Social Limitations 9

Awareness Barriers 11

Conclusion 13

Chapter III: Methodology 14

Types of Funding Agencies 14

Domestic Federal Funding 14

Private Foundations and Pharmaceutical Companies 14

 The Rationale for Choosing Specific Funding Type 15

 Description of Grant Announcement 16

Source 16

Department of Health and Human Services 16

The National Institute of Health (NIH) 16

 Announcement Summary 16

Proposal Review Criteria 17

Significance 17

Innovation 19

Approach 21

    Phase I: Needs Assessment and Partnership Development 21

    Phase II: Campaign Development & Implementation 22

Grant Review Process 23

Review Process 23

Expert Reviewers 23

Becca Keo-Meier, PhD(c) 24

Jermel Hilliard-Wallace, PhD(c) 24

Ashante’ Dobbs-Cooper, MSJ, MPH 24

Dr. Keith Green 24

Protection of Human Subjects 25

Chapter IV: Incorporation of Reviewer Comments 27

Reviewer 1 Comments 27

Reviewer 2 Comments 30

Reviewer 3 Comments 34

Reviewer 4 Comments 37

Chapter V: Final Version of the Grant Proposal 42

Project Summary/Abstract42

Project Narrative 42

Specific Aims 43

   Research Strategy 45

Significance 45

HIV and PrEP Recommendations45

HIV Related Stigma 45

Lived Trans-Experience 46

Project Narrative 42


Approach 50

Phase I: Needs Assessment and Partnership Development51

Phase II: Campaign Development & Implementation 52

Anticipated Reach 53

Evaluation and Assessment 54

“We are Warriors” Timeline 57

References 58

Appendix A: Funding Announcement Opportunity (FOA) 62

Appendix B: Expert Reviewer Form 81

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