KABAWIL: reducing Intersectional Stigmas

The goal of this study is to develop, culturally adapt, and evaluate KABAWIL, acommunity‐based intervention designed to reduce HIV‐related stigma and intersecting formsof stigma experienced by Indigenous communities in Guatemala. By addressing stigma atmultiple levels, the intervention seeks to improve engagement across the HIV Continuum ofCare, including HIV prevention, testing, linkage to care, treatment initiation, retentionin care, and viral suppression. In addition, the study will assess the feasibility,acceptability, appropriateness, and implementation potential of KABAWIL within Indigenouscommunities and local healthcare settings.HIV‐related stigma remains a significant barrier to HIV prevention and treatment inGuatemala, particularly among Indigenous populations who may also experiencediscrimination related to ethnicity, language, socioeconomic status, traditional healingpractices, gender, and sexual identity. These overlapping forms of marginalization, oftenreferred to as intersectional stigmas, can discourage individuals from seeking HIVtesting, accessing healthcare services, disclosing HIV status, and remaining engaged intreatment. KABAWIL is designed to address these interconnected barriers through aculturally grounded approach that incorporates Indigenous worldviews, community knowledgesystems, and traditional healing practices.This study will evaluate whether a culturally adapted version of the FRESH (FindingRespect and Ending Stigma around HIV) intervention can effectively reduce HIV‐related andintersectional stigma among Indigenous men and Indigenous healers. The study will alsoexamine whether participation in KABAWIL leads to improvements in HIV preventionbehaviors, HIV testing uptake, engagement in HIV care, treatment adherence, and otheroutcomes across the HIV Continuum of Care using a status‐neutral framework, whichsupports individuals regardless of their HIV status by promoting appropriate preventionor treatment services.Study ObjectivesThe study is organized around three primary aims:Aim 1: Cultural Adaptation of the InterventionResearchers will work collaboratively with community stakeholders to adapt the existingFRESH intervention to the cultural, linguistic, and social contexts of Indigenouscommunities in Guatemala. This process will involve individual interviews and focus groupdiscussions with:Indigenous men from participating communities Indigenous healers and traditional medicinepractitioners Healthcare providers and HIV service professionals HIV stigma and publichealth experts Maya knowledge keepers and community leadersInformation gathered during this phase will be used to refine intervention content,delivery methods, educational materials, and facilitation strategies to ensure culturalrelevance and community acceptability.Aim 2: Pilot Evaluation of KABAWILFollowing adaptation, researchers will conduct a pilot study to assess the intervention'spreliminary effectiveness. Participants will be assigned either to:An immediate intervention group that participates in KABAWIL workshops, or A 3‐monthwait‐list control group that receives the intervention after the comparison period.The intervention consists of one culturally tailored KABAWIL workshop designed to promotestigma reduction, increase HIV‐related knowledge, strengthen supportive attitudes andbehaviors, and improve engagement with HIV prevention and treatment services.Researchers will compare outcomes between groups to determine whether participation inKABAWIL reduces HIV‐related and intersectional stigma.Aim 3: Implementation EvaluationThe final phase of the study will assess how well KABAWIL can be implemented inreal‐world settings. Researchers will evaluate:Feasibility (whether the intervention can be delivered successfully) Acceptability(whether participants and stakeholders view it positively) Appropriateness (whether theintervention fits community needs and contexts) Potential barriers and facilitators tofuture implementation and scale‐up Participant ActivitiesBy combining evidence‐based stigma reduction strategies with Indigenous knowledge,cultural values, and community engagement, KABAWIL aims to create a sustainable andculturally responsive approach to improving HIV‐related health outcomes among Indigenouspopulations in Guatemala. Findings from this study will provide important evidenceregarding the effectiveness and implementation of stigma‐reduction interventions and mayinform future HIV prevention and care programs in Indigenous communities throughoutGuatemala and other settings with similar cultural and health equity challenges.