KABAWIL: Reducing Intersectional Stigmas

Kabawil: Adapting an Intervention to Reduce Intersectional Stigmas Among Indigenous Sexual Minority Men and Traditional Healers in Mesoamerica

The goal of this study is to develop and test KABAWIL, a culturally tailored intervention designed to reduce HIV-related and intersectional stigmas experienced by Indigenous communities in Guatemala and improve engagement across the HIV Continuum of Care. The study will also assess the feasibility, acceptability, and implementation of the intervention. The main questions it aims to answer are:

Can a culturally adapted version of the FRESH intervention reduce HIV-related and intersectional stigmas among Indigenous men and Indigenous healers? Does participation in KABAWIL improve outcomes related to HIV prevention, testing, treatment, and care using a status-neutral approach? Is KABAWIL feasible, acceptable, and appropriate for implementation in Indigenous communities in Guatemala?

Researchers will first adapt the existing FRESH intervention through interviews and focus groups with Indigenous men, Indigenous healers, healthcare providers, stigma experts, and Maya knowledge keepers. Researchers will then compare participants who receive KABAWIL immediately with participants assigned to a 3-month wait-list control group.

Participants will:

Participate in interviews or focus groups to help adapt the intervention (Aim 1).

Attend one of three KABAWIL workshops or be assigned to a 3-month wait-list control group (Aim 2).

Complete surveys and assessments measuring HIV-related intersectional stigma and HIV Continuum of Care outcomes before and after the intervention (Aim 2).

Participate in post-intervention interviews to provide feedback on the intervention's feasibility, acceptability, and implementation (Aim 3).

The goal of this study is to develop, culturally adapt, and evaluate KABAWIL, a community-based intervention designed to reduce HIV-related stigma and intersecting forms of stigma experienced by Indigenous communities in Guatemala. By addressing stigma at multiple levels, the intervention seeks to improve engagement across the HIV Continuum of Care, including HIV prevention, testing, linkage to care, treatment initiation, retention in care, and viral suppression. In addition, the study will assess the feasibility, acceptability, appropriateness, and implementation potential of KABAWIL within Indigenous communities and local healthcare settings.

HIV-related stigma remains a significant barrier to HIV prevention and treatment in Guatemala, particularly among Indigenous populations who may also experience discrimination related to ethnicity, language, socioeconomic status, traditional healing practices, gender, and sexual identity. These overlapping forms of marginalization, often referred to as intersectional stigmas, can discourage individuals from seeking HIV testing, accessing healthcare services, disclosing HIV status, and remaining engaged in treatment. KABAWIL is designed to address these interconnected barriers through a culturally grounded approach that incorporates Indigenous worldviews, community knowledge systems, and traditional healing practices.

This study will evaluate whether a culturally adapted version of the FRESH (Finding Respect and Ending Stigma around HIV) intervention can effectively reduce HIV-related and intersectional stigma among Indigenous men and Indigenous healers. The study will also examine whether participation in KABAWIL leads to improvements in HIV prevention behaviors, HIV testing uptake, engagement in HIV care, treatment adherence, and other outcomes across the HIV Continuum of Care using a status-neutral framework, which supports individuals regardless of their HIV status by promoting appropriate prevention or treatment services.

Study Objectives

The study is organized around three primary aims:

Aim 1: Cultural Adaptation of the Intervention

Researchers will work collaboratively with community stakeholders to adapt the existing FRESH intervention to the cultural, linguistic, and social contexts of Indigenous communities in Guatemala. This process will involve individual interviews and focus group discussions with:

Indigenous men from participating communities Indigenous healers and traditional medicine practitioners Healthcare providers and HIV service professionals HIV stigma and public health experts Maya knowledge keepers and community leaders

Information gathered during this phase will be used to refine intervention content, delivery methods, educational materials, and facilitation strategies to ensure cultural relevance and community acceptability.

Aim 2: Pilot Evaluation of KABAWIL

Following adaptation, researchers will conduct a pilot study to assess the intervention's preliminary effectiveness. Participants will be assigned either to:

An immediate intervention group that participates in KABAWIL workshops, or A 3-month wait-list control group that receives the intervention after the comparison period.

The intervention consists of one culturally tailored KABAWIL workshop designed to promote stigma reduction, increase HIV-related knowledge, strengthen supportive attitudes and behaviors, and improve engagement with HIV prevention and treatment services.

Researchers will compare outcomes between groups to determine whether participation in KABAWIL reduces HIV-related and intersectional stigma.

Aim 3: Implementation Evaluation

The final phase of the study will assess how well KABAWIL can be implemented in real-world settings. Researchers will evaluate:

Feasibility (whether the intervention can be delivered successfully) Acceptability (whether participants and stakeholders view it positively) Appropriateness (whether the intervention fits community needs and contexts) Potential barriers and facilitators to future implementation and scale-up Participant Activities

By combining evidence-based stigma reduction strategies with Indigenous knowledge, cultural values, and community engagement, KABAWIL aims to create a sustainable and culturally responsive approach to improving HIV-related health outcomes among Indigenous populations in Guatemala. Findings from this study will provide important evidence regarding the effectiveness and implementation of stigma-reduction interventions and may inform future HIV prevention and care programs in Indigenous communities throughout Guatemala and other settings with similar cultural and health equity challenges.

Inclusion Criteria:

• 18 year of age and older
• Self identifies as a man who has had sex with other men
• Self identifies as traditional healer

Exclusion Criteria:

• Requires working knowledge of Spanish
• Minor (under age 18)