{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T11:43:30Z","timestamp":1787312610580,"version":"build-2736575974"},"reference-count":65,"publisher":"Wiley","issue":"S1","license":[{"start":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T00:00:00Z","timestamp":1657584000000},"content-version":"vor","delay-in-days":11,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000056","name":"National Institute of Nursing Research","doi-asserted-by":"publisher","award":["R01 NR019009"],"award-info":[{"award-number":["R01 NR019009"]}],"id":[{"id":"10.13039\/100000056","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Int AIDS Soc."],"published-print":{"date-parts":[[2022,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>In Ghana, men who have sex with men (MSM) are estimated to be 11 times more likely to be living with HIV than the general population. Stigmas at the intersection of HIV, same\u2010sex and gender non\u2010conformity are potential key drivers behind this outsized HIV disease burden. Healthcare workers (HCWs) are essential to HIV prevention, care and treatment and can also be sources of stigma for people living with HIV and MSM. This article describes the process and results of adapting an evidence\u2010based HIV stigma\u2010reduction HCW training curriculum to address HIV, same\u2010sex and gender non\u2010conformity stigma among HCWs in the Greater Accra and Ashanti regions, Ghana.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Six steps were implemented from March 2020 to September 2021: formative research (in\u2010depth interviews with stigma\u2010reduction trainers [\n                      <jats:italic>n<\/jats:italic>\n                      = 8] and MSM living with HIV [\n                      <jats:italic>n<\/jats:italic>\n                      = 10], and focus group discussions with HCWs [\n                      <jats:italic>n<\/jats:italic>\n                      = 8] and MSM [\n                      <jats:italic>n<\/jats:italic>\n                      = 8]); rapid data analysis to inform a first\u2010draft adapted curriculum; a stakeholder adaptation workshop; triangulation of adaptation with HCW baseline survey data (\n                      <jats:italic>N<\/jats:italic>\n                      = 200) and deeper analysis of formative data; iterative discussions with partner organizations for further refinement; external expert review; and final adaptation with the teams of HCWs and MSM being trained to deliver the curriculum.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key themes emerging under four immediately actionable drivers of health facility intersectional stigma (awareness, fear, attitudes and facility environment) informed the adaptation of the HIV training curriculum. Based on the findings, existing curriculum exercises were placed in one of four categories: (1) Expand\u2014existing exercises that needed modifications to incorporate deeper MSM and gender non\u2010conformity stigma content; (2) Generate\u2014new exercises to fill gaps; (3) Maintain\u2014exercises to keep with no modifications; and (4) Eliminate\u2014exercises that could be dropped given training time constraints. New exercises were developed to address gender norms, the belief that being MSM is a mental illness and stigmatizing attitudes towards MSM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Getting to the \u201cheart of stigma\u201d requires understanding and responding to both HIV and other intersecting stigma targeting sexual and gender diversity. Findings from this study can inform health facility stigma reduction programming not only for MSM, but also for other populations affected by HIV\u2010related and intersectional stigma in Ghana and beyond.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jia2.25908","type":"journal-article","created":{"date-parts":[[2022,7,12]],"date-time":"2022-07-12T06:23:52Z","timestamp":1657607032000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":38,"title":["Using a mixed\u2010methods approach to adapt an HIV stigma reduction intervention to address intersectional stigma faced by men who have sex with men in Ghana"],"prefix":"10.1002","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8067-4192","authenticated-orcid":false,"given":"Laura","family":"Nyblade","sequence":"first","affiliation":[{"name":"Global Health Division International Development Group RTI International  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0737-7180","authenticated-orcid":false,"given":"Melissa A.","family":"Stockton","sequence":"additional","affiliation":[{"name":"Department of Psychiatry Columbia University Irving Medical Center  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5463-2738","authenticated-orcid":false,"given":"Khalida","family":"Saalim","sequence":"additional","affiliation":[{"name":"Global Health Division International Development Group RTI International  Washington DC USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gamji","family":"Rabiu Abu\u2010Ba'are","sequence":"additional","affiliation":[{"name":"Center for Interdisciplinary Research on AIDS School of Public Health Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sue","family":"Clay","sequence":"additional","affiliation":[{"name":"3C Regional Consultants  Zambia Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mutale","family":"Chonta","sequence":"additional","affiliation":[{"name":"3C Regional Consultants  Zambia Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Debbie","family":"Dada","sequence":"additional","affiliation":[{"name":"School of Nursing Yale University  New Haven Connecticut USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emmanuel","family":"Mankattah","sequence":"additional","affiliation":[{"name":"Educational Assessment &amp; 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