STIGMA AND GLOBAL HEALTH RESEARCH PROGRAM
 
RELEASE DATE:  June 20, 2002
 
RFA:  TW-03-001
 
PARTICIPATING INSTITUTES AND CENTERS (ICs):
Fogarty International Center (FIC) 
 (http://www.nih.gov/fic/)
Health Research Services Administration (HRSA) 
 (http://www.hrsa.gov)
National Center on Minority Health and Health Disparities (NCHMD)
 (http://ncmhd.nih.gov/)
National Human Genome Research Institute (NHGRI)
 (http://www.nhgri.nih.gov/)
National Institute of Allergy and Infectious Diseases (NIAID)
 (http://www.niaid.nih.gov/default.htm)
National Institute of Dental and Craniofacial Research (NIDCR)
 (http://www.nidcr.nih.gov/)
National Institute of Mental Health (NIMH) 
 (http://www.nimh.nih.gov/)
National Institute of Neurological Disorders and Stroke (NINDS)
 (http://www.ninds.nih.gov/)
National Institute on Alcohol Abuse and Alcoholism (NIAAA) 
 (http://www.niaaa.nih.gov/)
National Institute on Drug Abuse (NIDA) 
 (http://www.nida.nih.gov/)
Office of AIDS Research (OAR)/ NIH Office of the Director
 (http://www.nih.gov/od/oar/)
Office of Behavioral and Social Science Research (OBSSR)/ NIH Office of the 
Director
 (http://obssr.od.nih.gov/)
Office of Research on Women"s Health (ORWH)/ NIH Office of the Director
 (http://www4.od.nih.gov/orwh/)
Canadian Institutes of Health Research (CIHR)/Institute of Neurosciences,
Mental Health and Addiction (INMHA) with the International Development 
Research Centre (IDRC)
 (http://www.cihr.ca/, http://www.idrc.ca/)

LETTER OF INTENT RECEIPT DATE:  October 14, 2002
APPLICATION RECEIPT DATE:  November 14, 2002

THIS RFA CONTAINS THE FOLLOWING INFORMATION

o Purpose of this RFA
o Research Objectives
o Mechanisms of Support 
o Funds Available
o Eligible Institutions
o Individuals Eligible to Become Principal Investigators
o Special Requirements 
o Where to Send Inquiries
o Letter of Intent
o Submitting an Application
o Peer Review Process
o Review Criteria
o Receipt and Review Schedule
o Award Criteria
o Required Federal Citations

PURPOSE OF THIS RFA 

The purpose of this initiative is to stimulate investigator-initiated 
research on the role of stigma in health, and on how to intervene to prevent 
or mitigate its negative effects on the health and welfare of individuals, 
groups and societies world-wide.  Collaborative interdisciplinary 
applications are particularly encouraged.  The following Institutes and 
Centers from the U.S. Department of Health and Human Services (DHHS):  the 
Health Research Services Administration (HRSA), the NIH including: the 
Fogarty International Center (FIC), National Center on Minority Health and 
Health Disparities (NCHMD), National Institute of Neurological Disorders and 
Stroke (NINDS), National Human Genome Research Institute (NHGRI), National 
Institute of Alcohol Abuse and Alcoholism (NIAAA), National Institute of 
Allergy and Infectious Diseases (NIAID), National Institute of Dental and 
Craniofacial Research (NIDCR),  National Institute of Drug Abuse (NIDA), 
National Institute of Mental Health (NIMH), Office of AIDS Research, Office 
of Behavioral and Social Science Research (OBSSR), Office of Research on 
Women"s Health (ORWH), and the Canadian Institutes of Health Research (CIHR), 
seek domestic and international applications which address stigma-related 
issues, across a variety of global public health problems, among individuals 
and in society.  Relevant issues include:

1.  How stigma and its consequences, such as discrimination affect health 
(e.g. through physical and psychological abuse, denial of economic 
opportunities, poor provision and seeking of health care),
2.  How stigma associated with specific health conditions interacts with 
stigma associated with individual or group characteristics (such as gender, 
race, religion, sexual orientation and nationality),
3.  How to prevent and mitigate the negative effects of stigma and 
discrimination on health and health care,
4.  Development of quantitative and qualitative methods and techniques to 
investigate, measure and analyze the extent, degree and effects of stigma and 
the effectiveness of current and new interventions,
5.  Examination of the cultural, social, political and economic dimensions of 
stigma and its manifestations,
6.  Methods and safeguards to ensure safety of vulnerable research subjects.

Such research, which may range from basic to clinical and operational, 
requires expertise across a broad range of bio-medical, social and behavioral 
science fields.  The participants in this RFA therefore encourage 
interdisciplinary, domestic and international collaboration to build the 
scientific foundation of stigma research related to health.  Meritorious 
applications must also be relevant to the mission and interests of one or 
more of the participating Institutes or Centers.

This RFA is based on recommendations developed in conjunction with the NIH 
sponsored International Conference on Stigma and Global Health: Developing a 
Research Agenda, September 5-7, 2001, Bethesda, MD.  Applicants are 
encouraged to refer to the stigma conference website 
(www.stigmaconference.nih.gov) for extensive information related to the topic 
of this RFA including the agenda with links to speaker abstracts, 
commissioned background papers and a video-cast of the conference.

RESEARCH OBJECTIVES

The objectives of this initiative are to encourage research across a variety 
of scientific disciplines including the biomedical, social and behavioral 
sciences, to elucidate the etiology of stigma in relation to public health as 
well as to develop and test interventions to mitigate the negative effects of 
stigma on health outcomes.  Studies may examine stigma and public health in 
domestic, international and cross-cultural contexts, with an emphasis on 
studies that are relevant to global health issues.  Applicants are encouraged 
to undertake interdisciplinary studies, where possible, using behavioral, 
social and biomedical science approaches.

The initiative is also designed to attract investigators across a broad range 
of biomedical and non-biomedical fields, including but not limited to 
anthropology, epidemiology, infectious and non-infectious diseases, 
geography, sociology, psychology, psychiatry, neuroscience, law, genetics, 
ethics, economics, political science, biostatistics, evaluation and others. 

Background

According to a seminal work by sociologist Erving Goffman (1963 "Stigma: 
Notes on the Management of Spoiled Identity") a stigma is an attribute that   
according to prevailing societal attitudes - is deeply discrediting and 
reduces a person to one who is in some way tainted and can therefore be 
denigrated.  Individuals may internalize the stigmas applied to them by 
others.  Researchers, therefore, differentiate between the "felt" stigma a 
person perceives and "enacted" stigma, which refers to actions upon the 
individual expressed through various forms of discrimination. 

Stigma, when applied to health conditions, is a globally pervasive problem 
threatening psychological and physical health at the individual and group 
level.  Stigma helps to perpetuate health inequalities.  The poor treatment 
of an individual because of the stigma of the condition itself, or of another 
aspect of that individual"s being or position in society (such as gender, 
race, sexual orientation or socio-economic status), leads to poor outcomes 
and perpetuates other adverse health, social and economic consequences for 
the individual, their families and communities.  Felt stigma prevents 
individuals from coming forward for timely diagnosis and treatment and 
impairs their ability for self-care, to access care or to participate in 
research studies designed to find solutions.  Enacted stigma perpetuates 
public health problems and prevents societies from appropriately addressing 
health care issues at the community and national levels with the appropriate 
delivery, funding and support of research, health care services and legal and 
educational interventions. 

Many diseases and conditions, which persist or worsen if left untreated, 
affect a person"s ability to fulfill necessary, culturally expected and 
economically productive roles in society.  The burden of their continued care 
may then fall upon families and communities lacking adequate resources or 
support.  For this reason, stigma and discrimination may greatly magnify the 
social and economic, as well as personal consequences of such diseases and 
conditions, often well beyond their prevalence in the population. 

In the case of infectious disease (for example, sexually transmitted 
diseases), stigma and discrimination related to the mode of transmission and 
preexisting attitudes towards some affected individuals can lead to fear of 
disclosure, inadequate and inappropriate treatment of all affected, and the 
further spread of a disease which might otherwise be contained.  The effects 
on individuals, families, communities and nations can be devastating, as 
illustrated by the HIV/AIDS epidemic, particularly in Sub-Saharan Africa. 

The disability and loss of productivity due to treatable mental illnesses and 
neurological disorders (such as depression, schizophrenia, epilepsy, movement 
disorders, substance abuse disorders, mental retardation and cerebral palsy), 
when inadequately treated due to stigma and discrimination, contribute 
greatly to the burden of illness on societies around the world (for more 
information please see the "World Health report 2001:  Mental Health-New 
Understanding, New Hope" and the Institute of Medicine report on 
"Neurological, Psychiatric and Developmental Disorders: meeting the Challenge 
of the Developing World", 2001, available at 
http://books.nap.edu/books/0309071925/html/). 

The same is true of other physical and developmental health conditions 
(including those which are disfiguring such as craniofacial disorders, and 
those that are physically disabling, such as spinal cord injury leading to 
paralysis) which if treated, mitigated or accommodated need not serve as 
barriers to full and productive lives.  Yet stigma and discrimination often 
prevent the necessary societal action to treat, research and accommodate such 
conditions.  Other public health problems, such as domestic violence and 
abuse, when ignored because of the associated stigma, perpetuate the same 
problems in individuals and across generations, along with other, often 
stigmatized health problems such as mental illnesses, drug and alcohol 
addiction and abuse. 

To have an impact, research on stigma-related health problems requires the 
participation of investigators across a broad range of biomedical and non-
biomedical fields.  Interdisciplinary studies are needed which use current 
behavioral, social and biomedical approaches to elucidate the etiology of 
stigma in relation to health as well as develop and test interventions to 
mitigate the negative effects of stigma on health outcomes.  Finally, 
researchers must better understand the policy-making process so they can work 
to ensure that research results have an impact.

Understanding the causes, consequences and effective interventions for 
stigma-related issues and problems has the potential to significantly improve 
treatment and care particularly for public health problems of global 
importance.  In the same way that the effects of stigma magnify the personal 
and societal problems related to such diseases and disorders, preventing or 
mitigating stigma and its effects can profoundly improve the lives of 
individuals and, by extension, their families and the larger society. 

The public health community has demonstrated increasing awareness of the role 
of stigma in many diseases and disorders.  Recent conferences have focused on 
the role of stigma in mental illnesses including depression and 
schizophrenia, HIV/AIDS and epilepsy.  These conferences were convened by 
organizations including the Health and Development Networks with UNAIDS, the 
United States Substance Abuse and Mental Health Services Administration, the 
World Health Organization, and the World Psychiatric Association. 

This RFA is informed as well by the recent U.S. National Institutes of Health 
International Conference on Stigma and Global Health: Developing a Research 
Agenda (www.stigmaconference.nih.gov).  This conference was convened by the 
Fogarty International Center of the NIH in partnership with various other NIH 
institutes and offices along with other U.S. agencies, and domestic and 
international organizations.  More than 250 participants from 30 nations, 
including 23 developing countries, discussed stigma associated with a variety 
of illnesses and conditions including HIV/AIDS, mental health, epilepsy, 
physical anomalies, alcohol and drug abuse, physical and sexual abuse, 
genetics, race and gender. Scientists and other experts encompassing the 
health, social and behavioral sciences, media, law, politics and economics 
focused on stigma as it relates to global public health.  They examined both 
what is known about the causes and consequences of stigma and what can be 
done to prevent or minimize its negative effects on the health of individuals 
and societies.

One outcome of the conference was a set of research recommendations for 
stigma and its relationship to a variety of global public health problems.  
The recommendations include research to:
o Further elucidate the etiology of stigma, 
o Investigate the health consequences of stigma,
o Develop methodology for studying stigma with respect to health,
o Evaluate and develop new effective interventions to deal with stigma,
o Lay the groundwork for guidelines on ethical conduct of studies on 
stigmatized individuals and groups who may face further negative effects, 
including physical violence or social isolation, because of their 
participation in such studies.

Research Topics

Studies of stigma are encouraged across physical and mental health conditions 
(including addictions), care settings, groups, outcomes and interventions, 
including research on the social, economic, cultural and political factors in 
both creating and intervening in stigmatization of health conditions. This 
RFA encourages interdisciplinary studies throughout whenever appropriate to 
the research question. Ethnographic and other areas of social science 
research in particular will be necessary to fully understand the role of 
stigma within a given society or group and to design appropriate 
interventions. The ways stigma is applied, perceived and measured in other 
cultures are relevant avenues of inquiry and ethnographic and comparative 
studies are encouraged alone or as components of other studies.

Other relevant research topics include but are not limited to the following:

1. The role of stigma in specific public health problems, diseases or 
disorders, and its implications for issues from etiology to interventions and 
public policy, 

2. The implications of stigma for access to care and treatment, and how 
stigma affects outcomes across health conditions,

3. Systematic studies to determine psychological, social, economic, cultural 
and political factors that operate in the creation of stigma and how they 
link to stereotypes, discrimination and mistreatment in the context of health 
problems and health care systems, 

4. Approaches to ensure that medical advances, which can be used to treat or 
prevent stigmatized conditions, effectively reach appropriate populations,

5. Development of tools to study and document stigma and its impact on 
accurate determination of incidence and prevalence of health conditions, and 
to estimate the risk for over- or under-diagnosis as a result of stigma-
related influences,

6. Evaluation of which interventions work for stigma-related health problems, 
the characteristics of successful interventions, demonstration of successful 
interventions that can be scaled up or generalized to other stigmatized 
public health problems and/or to other populations and cultures,

7.The role of stigma in provision of health care including, quality and 
extent of available treatment and care, the quality of the patient/health 
care practitioner relationship, the role of the provider"s attitude in 
perpetuating stigma and the role of stigma in disclosure of disease status 
during medical visits,

8. The role of disclosure of disease in an individuals" personal or 
professional life and its relationship to perceived stigma, 

9. Identification of methods to minimize (or eliminate) the consequences of 
stigma/stigmatization on the recognition and diagnosis of health conditions 
and on options for treatment and/or rehabilitation,

10. Social, cultural and environmental influences on perceptions of and 
reactions to stigma/discrimination among individuals, families and 
communities, and on the resources available for coping with or ameliorating 
its negative health consequences,  

11. The interaction of social systems including gender, culture, politics, 
economics and the law in creating stigmas and the examination of the 
interplay between different kinds of stigmas as well as the combined impact 
on individuals, families, and groups,

12. The involvement of social, political, economic and legal systems in 
creating appropriate, effective and culturally sensitive interventions to 
combat stigma and the negative effects of stigma,

13. The actual and potential roles of media in creating, disseminating and 
intervening in stigma-related attitudes and actions,

14. The relationship between attributions about the causes/etiologies of 
particular diseases and disorders and the degree to which those with, or at 
risk for, the disorder are stigmatized. For example: does the public view a 
disease or disorder as more or less stigmatizing when it may be associated 
with a specific genetic predisposition, is this perception different for 
different diseases and disorders, for example diseases such as cancer, 
neurological and neuropsychiatric disorders such as epilepsy, movement 
disorders, schizophrenia and bipolar disorder, or conditions in which there 
is a clear behavioral component (e.g. drug abuse, obesity)?

Specific Research Areas of Interest to Stigma and Global Health RFA Sponsors:

The FIC is interested in applications on stigma and health topics relevant to 
and involving low to middle income countries of the developing world. Special 
consideration will be given to meritorious interdisciplinary applications 
from, or in collaboration with, developing country investigators.

NCMHD would like to encourage applications that have minority health or 
health disparity focus.

NIAAA is interested in supporting applications that address the association 
of stigma with the detection, prevention and treatment of alcohol use 
disorders. Of particular interest are applications that address alcohol abuse 
and addiction in populations that bear a greater burden of stigma (i.e. 
pregnant women) and alcohol related birth defects (such as Fetal Alcohol 
Syndrome). Applications that address the stigma associated with alcohol and 
other health conditions, such as HIV AIDS, will also be considered.  Studies 
on the role of stigma in the development of alcohol-related policies and the 
delivery of services are also encouraged.

NIAID encourages applications addressing the impact of stigma on control and 
treatment of infectious diseases. Of particular interest is research to 
develop and evaluate strategies to prevent or minimize the negative physical, 
cognitive, and social consequences of HIV infection, including the 
stigmatization of persons with or at risk for HIV infection. NIAID is 
particularly interested in applications with an international/developing 
country focus.

NIDA is interested in supporting applications that address the causes and 
consequences of stigma in drug abusing and addicted individuals and 
populations, including the impact on stigma on the availability and provision 
of treatment and prevention services. Studies on interventions directed at 
reducing stigma in these populations are encouraged as well.

NIDCR is interested in supporting research to identify, prevent, or 
ameliorate consequences of stigma related to socially perceived variations or 
changes in orofacial appearance or function. Such changes may, for example, 
result from orofacial injuries or from congenital craniofacial anomalies, 
such as cleft lip and palate, disfiguring infectious diseases such as noma, 
oral facial cancers or ablative cancer surgeries affecting orofacial 
structures, edentulousness, malocclusion, or other orofacial diseases/ 
conditions.   

NHGRI would like to encourage applications on stigma-related issues related 
to genetic disorders.

NIMH encourages research on stigma related to neuropsychiatric disorders and 
research on AIDS stigma and prevention of HIV transmission and its 
consequences including descriptive cross-sectional studies of stigma, 
longitudinal research studies and intervention studies.

NINDS encourages research on stigma related problems across the spectrum of 
neurological disorders to reduce the burden of neurological disease borne by 
every age group and segment of society all over the world. 

OAR is interested in supporting applications that address the role of stigma 
and discrimination in the HIV/AIDS pandemic.  This includes basic research on 
the causes and consequences of HIV/AIDS-associated stigma and discrimination, 
as well as intervention research to ameliorate them. 

ORWH would like to encourage applications, across the spectrum of possible 
research topics, which include in the research design scientific analyses 
aimed at delineating sex/gender differences. The results of such analyses are 
expected to be particularly important when designing and testing appropriate 
interventions to have the best possible outcomes.

The HIV/AIDS Bureau, HRSA, is interested in supporting the evaluation of 
interventions to reduce stigma as a barrier to the care and treatment of 
those living with HIV/AIDS.  Examples of potential interventions include 
training of health care providers, community involvement in HIV program 
planning, and the inclusion of people living with HIV/AIDS in program 
planning and as staff or volunteers in care and support programs.  Programs 
that tie decreases in stigma to increased access to care and improved quality 
of care are of particular interest.

The Institute of Neurosciences, Mental Health and Addiction  (INMHA) of the 
Canadian Institutes of Health Research (CIHR) is interested in supporting 
applications from Canadians or, in collaboration with the Canadian 
International Development Research Center (IDRC), in co-sponsoring proposals 
originating in and responding to priorities of developing countries and with 
a Canadian component. Eligible applications for CIHR/INMHA include those 
dealing with research on stigma related to neurological disorders, mental 
illnesses and addictions which are aimed at finding innovative, effective and 
evidence-based means to reduce discrimination, improve access to services and 
to raise public awareness through education.

Contact the representatives of the participating Agencies, Institutes or 
Centers (ICs) listed in the  "Where to Send Inquiries" section of this RFA or 
visit individual Agency and IC websites for more information about topics of 
interest to each. Additional research questions and other information of 
specific interest to individual participating Agencies and ICs in the context 
of this RFA can be found at:  http://www.nih.gov/fic/programs/stigma.html.

MECHANISM OF SUPPORT

This RFA will use the National Institutes of Health (NIH) research project 
grant (R01) and the developmental/exploratory grant (R21) award mechanisms.  
Note that the R21 mechanism is specifically intended to support innovative 
ideas where preliminary data as evidence of feasibility are sparse or do not 
exist.  R21 grants are not intended for large-scale undertakings or to 
support or supplement ongoing research.  Rather, R21-supported projects are 
intended to serve as a basis for planning and strengthening future research 
project grant applications (R01).

This RFA also uses just-in-time concepts and the modular grant format (see 
http://grants.nih.gov/grants/funding/modular/modular.htm). Specifically, if 
you are submitting an application with direct costs in each year of $250,000 
or less, use the modular format (modules of $25,000).  Otherwise follow the 
instructions for non-modular research grant applications. 

Applications submitted by foreign institutions can request facilities and 
administrative (F&A) costs up to a maximum of eight percent.  Please see the 
web site http://grants.nih.gov/grants/guide/notice-files/NOT-OD-01-028.html 
for more information on allowable F&A costs for foreign grants and domestic 
grants with foreign components.

This RFA is issued for fiscal year (FY) 2003 and the anticipated award start 
date is July 2003.  Applications submitted in response to this RFA may have a 
project period of up to five years for R01 and up to three years for R21 
grant applications.  As an applicant you will be solely responsible for 
planning, directing, and executing the proposed project.

At this time, it is not known if this RFA will be reissued. Any future 
unsolicited competing continuation applications based on this project may 
compete with all NIH investigator-initiated applications and be reviewed 
according to the customary peer review procedures. 

FUNDS AVAILABLE 

The participating ICs intend to commit approximately $2.5 million in FY 2003 
to fund up to 12 new competitive grants in response to this RFA. 

R21 grant applicants may request a project period of up to three years with a 
total direct cost of $100,000 per year. 

R01 grant applicants may request a project period of up to five years. An 
applicant may request a budget up to 
1) $500,000 direct costs per year for applications in which comparative or 
intervention studies at two or more international sites are planned, and 
which involve an international team of investigators.  No one site may be 
allocated more that half the budget.
2) $200,000 direct costs per year for all other projects (i.e. those that 
will take place only in a single country, do not propose comparative or 
intervention studies, do not involve an international collaboration). 

Because the nature and scope of the proposed research will vary from 
application to application, it is anticipated that the size and duration of 
each award will also vary, with multidisciplinary collaborative, 
international applications requiring more funding and time. Although the 
financial plans of the IC(s) provide support for this program, awards 
pursuant to this RFA are contingent upon the availability of funds and the 
receipt of a sufficient number of meritorious applications. Each award will 
be administered by one of the participating NIH ICs or other participating 
agencies although several may participate in funding of any given 
application.

The Canadian Institute for Health Research (CIHR) along with the Canadian 
International Development Research Centre (IDRC) will consider meritorious 
applications, relevant to their missions, from Canadian applicant 
institutions.  CIHR will make the award of grants for meritorious 
applications of interest to them.  Applicants who wish to have their projects 
considered for funding by CIHR should include with their application a letter 
stating that their application and summary statement may be shared with CIHR 
and IDRC.

ELIGIBLE INSTITUTIONS

You may submit (an) application(s) if your institution is in one of the 
following categories:

o For-profit or non-profit organizations 
o Public or private institutions, such as universities, colleges, hospitals, 
and laboratories 
o Units of State and local governments
o Agencies of the Federal government 
o Domestic or foreign institutions or organizations
o Faith-based organizations 
 
INDIVIDUALS ELIGIBLE TO BECOME PRINCIPAL INVESTIGATORS   

Any individual with the skills, knowledge, and resources necessary to carry 
out the proposed research is invited to work with their institution to 
develop an application for support.  Individuals from underrepresented racial 
and ethnic groups as well as individuals with disabilities are always 
encouraged to apply for NIH programs.   

SPECIAL REQUIREMENTS

Two meetings of grantees of these awards will be held in the Washington, D.C. 
area (one in the second year and one in the fourth year of the grant period) 
to share information and discuss new insights on stigma and health, in 
particular, stigma intervention strategies. For these meetings, funds should 
be budgeted for travel by the PI and/or other relevant individuals with 
significant day-to-day involvement in the activities performed under this 
award.

WHERE TO SEND INQUIRIES

We encourage inquiries concerning this RFA and welcome the opportunity to 
answer questions from potential applicants.  Inquiries may fall into three 
areas:  scientific/research, peer review, and financial or grants management 
issues.

o GENERAL INQUIRIES regarding the scope and content of this Request for 
Applications should be directed to:

Kathleen Michels, Ph.D.
Program Director
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Telephone:  301-435-6031
Fax:  301-402-0779
Email:  [email protected]

o Direct your questions about SCIENTIFIC/RESEARCH ISSUES to the contacts 
below (additional specific research questions of interest to participating 
ICs can be found in the "Research Topics" section of this RFA and at 
http://www.nih.gov/fic/programs/stigma.html): 

CANADA:

CANADIAN INSTITUTES OF HEALTH RESEARCH and 
INTERNATIONAL DEVELOPMENT RESEARCH CENTER

Astrid Eberhart
Institute Liaison
Institute of Neurosciences, Mental Health and Addiction
Canadian Institutes of Health Research
410 Laurier Avenue W., 9th Floor
Address Locator 4209A
Ottawa, ON  K1A 0W9
Telephone:  613-941-4643
Fax:  613-941-1040
Email:  [email protected]

UNITED STATES:

HEALTH RESOURCES AND SERVICES ADMINISTRATION 

Laura Cheever, M.D., Sc.M.
Chief, HIV Education Branch
Health Resources and Services Administration
Parklawn Building, Room 7-29
5600 Fishers Lane 
Rockville, MD  20857
Telephone:  301-443-3067
Fax:  301-443-9887
Email:  [email protected]

NATIONAL INSTITUTES OF HEALTH:

FOGARTY INTERNATIONAL CENTER

Kathleen Michels, Ph.D.
Program Director
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892
Telephone:  301-435-6031
Fax:  301-402-0779
Email:  [email protected]

NATIONAL HUMAN GENOME RESEARCH INSTITUTE 

Jean E. McEwen, J.D., Ph.D.
Program Director
Ethical, Legal, and Social Implications Program
National Human Genome Research Institute
National Institutes of Health
Building 31, Room B2B07
31 Center Drive, MSC 4997
Bethesda, MD  20892-2033
Telephone:  301-402-4997
Fax:  301-402-1950
Email:  [email protected]

NATIONAL INSTITUTE OF ALCOHOL ABUSE AND ALCOHOLISM 

Margaret M. Murray, M.S.W.
Chief, International and Health Education Programs Branch
National Institute on Alcohol Abuse and Alcoholism
National Institutes of Health
6000 Executive Boulevard, Suite 302
Rockville, MD 20852
Telephone:  301-443-2594
Email:  [email protected] 

NATIONAL INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES

Rodney Hoff, D.Sc., MPH 
Vaccine and Prevention Research Program 
Division of AIDS, NIAID/NIH 
6700B Rockledge, Room 4157, MSC 7620
Bethesda, MD 20892-7620 
Telephone:  301 496 6179 
Email:  [email protected] 

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH 

Patricia S. Bryant, Ph.D.
Director, Behavioral and Social Science Research
Division of Population and Health Promotion Sciences
National Institute of Dental and Craniofacial Research
National Institutes of Health
Building 45, Room 4AN24E, MSC 6402
Bethesda, MD 20892-6402
Telephone:  301-594-2095
Fax:  301-480-8318
Email:  [email protected]

NATIONAL INSTITUTE ON DRUG ABUSE 

Minda R. Lynch, Ph.D.
Branch Chief 
Behavioral and Cognitive Sciences Research Branch
Division of Neuroscience and Behavioral Research
National Institute on Drug Abuse
National Institutes of Health
6001 Executive Boulevard, Room 4282, MSC 9555
Bethesda, MD  20892
Telephone:  301-435-1322
Fax:  301-594-6043
Email:  [email protected]

Leslie C. Cooper, Ph.D., M.P.H.,B.S.N.,R.N.
Research Program Director for the Epidemiology, Etiology and Consequences of 
Drug Abuse in Special Populations and Health Disparities. 
Captain/USPHSCC
Nurse Epidemiologist
NIH/NIDA/DESPR
6001 Executive Boulevard, Room 5167, MSV 9589
Bethesda, MD 20892-9589
Telephone:  301-402-1906
Fax:  301-480-2543 
Email:  [email protected]

NATIONAL INSTITUTE OF MENTAL HEALTH 

Emeline Otey, Ph.D.
Division of Mental Disorders, Behavioral Research and AIDS 
National Institute of Mental Health 
6001 Executive Boulevard, Room 6186, MSC 9625 
Bethesda, MD  20892-9625 
Telephone:  301-443-1636 
Fax:  301-443-4611 
Email:  [email protected] 

Christopher M. Gordon, Ph.D.
Division of Mental Disorders, Behavioral Research, and AIDS
National Institute of Mental Health
6001 Executive Boulevard, Room 6204, MSC 9619
Bethesda, MD  20892-9619
Telephone:  301-443-1613
Email:  [email protected]

NATIONAL INSTITUTE OF NEUROLOGICAL DISORDERS AND STROKE 

Margaret P. Jacobs
Program Director, Epilepsy Research
National Institute of Neurological Disorders and Stroke, NIH
Neuroscience Center
6001 Executive Boulevard, Room 2138, MSC 9523
Bethesda, MD  20892-9523   
Telephone:  301-496-1917
Fax:  301-480-2424
Email:  [email protected]

OFFICE OF THE DIRECTOR, NIH:

OFFICE OF AIDS RESEARCH 

Paul A. Gaist, Ph.D., M.P.H.
Health Scientist Administrator
Office of AIDS Research
Office of the Director
National Institutes of Health
Building 31, Room 4C06
31 Center Drive
Bethesda,MD  20892
Telephone:  301-402-3555
Fax:  301-496-4843
E-mail:  [email protected]

OFFICE OF RESEARCH ON WOMEN"S HEALTH

Joyce Rudick
Director, Programs and Management
Building 1, Room 201
9000 Rockville Pike, MSC 0161
Bethesda, MD 20892-0161
Telephone:  301-402-1770
Fax:  301-402-1798
Email:  [email protected]

o Direct your questions about peer review issues to:

Mariela C. Shirley, Ph.D.
Risk, Prevention, and Health Behavior IRG 
Center for Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1102, MSC 7848
Bethesda, MD 20892-7848
Bethesda, MD  20817 (For express/courier service)
Telephone:  301-435-3554
Fax:  301-480-3962
Email:  [email protected]

o Direct your questions about financial or grants management matters to:

FOGARTY INTERNATIONAL CENTER

Bruce Butrum
Grants Management Officer
Grants Office
Fogarty International Center
Building 31, Room B2C29
31 Center Drive,MSC 2220
Bethesda, MD  20892-2220
Telephone:  301-496-1670
Fax:  301-402-0779
Email:  [email protected]

NATIONAL INSTITUTE OF DENTAL AND CRANIOFACIAL RESEARCH 

H. George Hausch, Ph.D.
Division of Extramural Activities
National Institute of Dental and Craniofacial Research
National Institutes of Health
Building 45, Room 4AN-44K, MSC 6402
Bethesda, MD 20892-6402
Telephone:  301-594-2904
Fax:  301-480-8303
Email:  [email protected]

LETTER OF INTENT
 
Prospective applicants are asked to submit a letter of intent that includes 
the following information:

o Descriptive title of the proposed research
o Name, address, and telephone number, of the Principal Investigator
o Names of other key personnel 
o Participating institutions
o Number and title of this RFA 

Although a letter of intent is not required, is not binding, and does not 
enter into the review of a subsequent application, the information that it 
contains allows IC staff to estimate the potential review workload and plan 
the review.
 
The letter of intent is to be sent by the date listed at the beginning of 
this document.  The letter of intent should be sent to:

Kathleen Michels, Ph.D.
Program Director
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Telephone:  301-435-6031
Fax:  301-402-0779
Email:  [email protected]

SUBMITTING AN APPLICATION

Applications must be prepared using the PHS 398 research grant application 
instructions and forms (rev. 5/2001).  The PHS 398 is available at 
http://grants.nih.gov/grants/funding/phs398/phs398.html in an interactive 
format.  For further assistance contact GrantsInfo, Telephone (301) 710-0267, 
Email: [email protected].
 
SUPPLEMENTAL INSTRUCTIONS:
 
Description section:  If a country other than the home country of the 
applicant institution is involved in the application, please include the name 
of the other country or countries in your description.

Canadian Applicants:  Applicants who wish to have their projects considered 
for funding by CIHR and IDRC must include with their application a letter 
stating that their application and summary statement should be shared with 
CIHR and IDRC.

R21 applications:  limit of 20 pages for the Research Plan (sections a-d).

SPECIFIC INSTRUCTIONS FOR MODULAR GRANT APPLICATIONS: Applications requesting 
up to $250,000 per year in direct costs must be submitted in a modular grant 
format.  The modular grant format simplifies the preparation of the budget in 
these applications by limiting the level of budgetary detail.  Applicants 
request direct costs in $25,000 modules.  Section C of the research grant 
application instructions for the PHS 398 (rev. 5/2001) at 
http://grants.nih.gov/grants/funding/phs398/phs398.html includes step-by-step 
guidance for preparing modular grants.  Additional information on modular 
grants is available at http://grants.nih.gov/grants/funding/modular/modular.htm.

USING THE RFA LABEL:  The RFA label available in the PHS 398 (rev. 5/2001) 
application form must be affixed to the bottom of the face page of the 
application.  Type the RFA number on the label.  Failure to use this label 
could result in delayed processing of the application such that it may not 
reach the review committee in time for review.  In addition, the RFA title 
and number must be typed on line 2 of the face page of the application form 
and the YES box must be marked.  The RFA label is also available at: 
http://grants.nih.gov/grants/funding/phs398/label-bk.pdf.
 
SENDING AN APPLICATION TO THE NIH:  Submit a signed, typewritten original of 
the application, including the Checklist, and four signed photocopies, in one 
package to:
 
Center For Scientific Review
National Institutes of Health
6701 Rockledge Drive, Room 1040, MSC 7710
Bethesda, MD  20892-7710
Bethesda, MD  20817 (For express/courier service)
 
At the time of submission, one additional copy of the application must be 
sent to:

Kathleen Michels, Ph.D.
Program Director
Division of International Training and Research
Fogarty International Center
Building 31, Room B2C39
31 Center Drive, MSC 2220
Bethesda, MD  20892-2220
Phone:  301-435-6031
Fax:  301-402-0779
Email:  [email protected]

APPLICATION PROCESSING:  Applications must be received by the application 
receipt date listed in the heading of this RFA.  If an application is 
received after that date, it will be returned to the applicant without 
review.
 
The Center for Scientific Review (CSR) will not accept any application in 
response to this RFA that is essentially the same as one currently pending 
initial review, unless the applicant withdraws the pending application.  The 
CSR will not accept any application that is essentially the same as one 
already reviewed. This does not preclude the submission of substantial 
revisions of applications already reviewed, but such applications must 
include an Introduction addressing the previous critique.

PEER REVIEW PROCESS  
 
Upon receipt, applications will be reviewed for completeness by the CSR and 
responsiveness by the participating Institutes and Centers. Incomplete 
applications will be returned to the applicant without further consideration. 
If the application is not responsive to the RFA, CSR staff may contact the 
applicant to determine whether to return the application to the applicant or 
submit it for review in competition with unsolicited applications at the next 
appropriate NIH review cycle.

Applications that are complete and responsive to the RFA will be evaluated 
for scientific and technical merit by an appropriate peer review group 
convened by the CSR in accordance with the review criteria stated below.  As 
part of the initial merit review, all applications will:

o Receive a written critique
o May undergo a process in which only those applications deemed to have the 
highest scientific merit, generally the top half of the applications under 
review, will be discussed and assigned a priority score
o Receive a second level review by the National Advisory Council of the 
relevant participating IC or Board. 
 
REVIEW CRITERIA

The goals of NIH-supported research are to advance our understanding of 
biological systems, improve the control of disease, and enhance health.  In 
the written comments, reviewers will be asked to discuss the following 
aspects of your application in order to judge the likelihood that the 
proposed research will have a substantial impact on the pursuit of these 
goals: 

o Significance 
o Approach 
o Innovation
o Investigator
o Environment
  
The scientific review group will address and consider each of these criteria 
in assigning your application"s overall score, weighting them as appropriate 
for each application.  Your application does not need to be strong in all 
categories to be judged likely to have major scientific impact and thus 
deserve a high priority score.  For example, you may propose to carry out 
important work that by its nature is not innovative but is essential to move 
a field forward.

(1) SIGNIFICANCE:  Does your study address an important problem related to 
stigma and health? If the aims of your application are achieved, how do they 
advance scientific knowledge?  What will be the effect of these studies on 
the concepts or methods that drive this field?

(2) APPROACH:  Are the conceptual framework, design, methods, and analyses 
adequately developed, well integrated, and appropriate to the aims of the 
project?  Do you acknowledge potential problem areas and consider alternative 
tactics? Do your project use multidisciplinary tools, techniques and 
expertise to address stigma and health at various levels?

(3) INNOVATION:  Does your project employ novel concepts, approaches or 
methods? Are the aims original and innovative?  Does your project challenge 
existing paradigms or develop new methodologies or technologies?

(4) INVESTIGATOR: Are you appropriately trained and well suited to carry out 
this work?  Is the work proposed appropriate to your experience level as the 
principal investigator and to that of other researchers (if any)?

(5) ENVIRONMENT:  Does the scientific environment in which your work will be 
done contribute to the probability of success?  Do the proposed experiments 
take advantage of unique features of the scientific environment or employ 
useful collaborative arrangements?  Is there evidence of institutional 
support?

ADDITIONAL REVIEW CRITERIA: In addition to the above criteria, your 
application will also be reviewed with respect to the following:

o SPECIFIC R21 REVIEW CRITERIA:  
Innovation of the project and potential significance of the proposed research 
will be the major considerations in the evaluation of the R21 exploratory 
grant mechanism.  Because the R21 is designed to support innovative ideas, 
preliminary data as evidence of feasibility of the project are not required.  
However, the applicant is also responsible for presenting the background 
literature that provides some basis for the approach and for developing a 
rigorous research plan.  Relevant pilot data should be cited when available. 

o PROTECTIONS:  The adequacy of the proposed protection for humans, animals, 
or the environment, to the extent they may be adversely affected by the 
project proposed in the application.

o INCLUSION:  The adequacy of plans to include subjects from both genders, 
all racial and ethnic groups (and subgroups), and children as appropriate for 
the scientific goals of the research.  Plans for the recruitment and 
retention of subjects will also be evaluated. (See Inclusion Criteria 
included in the section on Federal Citations, below)

o DATA SHARING:  The adequacy of the proposed plan to share data. 

o BUDGET:  The reasonableness of the proposed budget and the requested period 
of support in relation to the proposed research.

RECEIPT AND REVIEW SCHEDULE

Letter of Intent Receipt Date:  October 14, 2002
Application Receipt Date:  November 14, 2002
Peer Review Date:  February 2003
Council Review:  May 2003
Earliest Anticipated Start Date:  July 1, 2003

AWARD CRITERIA

Award criteria that will be used to make award decisions include:

o Scientific merit (as determined by peer review)
o Availability of funds
o Programmatic priorities
 
REQUIRED FEDERAL CITATIONS 

MONITORING PLAN AND DATA SAFETY AND MONITORING BOARD: 
Research components involving Phase I and II clinical trials must include 
provisions for assessment of patient eligibility and status, rigorous data 
management, quality assurance, and auditing procedures.  In addition, it is 
NIH policy that all clinical trials require data and safety monitoring, with 
the method and degree of monitoring being commensurate with the risks (NIH 
Policy for Data Safety and Monitoring, NIH Guide for Grants and Contracts, 
June 12, 1998: http://grants.nih.gov/grants/guide/notice-files/not98-084.html).  

INCLUSION OF WOMEN AND MINORITIES IN CLINICAL RESEARCH: It is the policy of 
the NIH that women and members of minority groups and their sub-populations 
must be included in all NIH-supported clinical research projects unless a 
clear and compelling justification is provided indicating that inclusion is 
inappropriate with respect to the health of the subjects or the purpose of the 
research.  This policy results from the NIH Revitalization Act of 1993 
(Section 492B of Public Law 103-43).

All investigators proposing clinical research should read the AMENDMENT "NIH 
Guidelines for Inclusion of Women and Minorities as Subjects in Clinical 
Research - Amended, October, 2001," published in the NIH Guide for Grants and 
Contracts on October 9, 2001 (http://grants.nih.gov/grants/guide/notice-
files/NOT-OD-02-001.html), a complete copy of the updated Guidelines are 
available at 
http://grants.nih.gov/grants/funding/women_min/guidelines_amended_10_2001.htm

The amended policy incorporates: the use of an NIH definition of clinical 
research, updated racial and ethnic categories in compliance with the new OMB 
standards, clarification of language governing NIH-defined Phase III clinical 
trials consistent with the new PHS Form 398, and updated roles and 
responsibilities of NIH staff and the extramural community.  The policy 
continues to require for all NIH-defined Phase III clinical trials that: a) 
all applications or proposals and/or protocols must provide a description of 
plans to conduct analyses, as appropriate, to address differences by 
sex/gender and/or racial/ethnic groups, including subgroups if applicable, 
and b) investigators must report annual accrual and progress in conducting 
analyses, as appropriate, by sex/gender and/or racial/ethnic group 
differences.

INCLUSION OF CHILDREN AS PARTICIPANTS IN RESEARCH INVOLVING HUMAN SUBJECTS:  
The NIH maintains a policy that children (i.e., individuals under the age of 
21) must be included in all human subjects research, conducted or supported 
by the NIH, unless there are scientific and ethical reasons not to include 
them. This policy applies to all initial (Type 1) applications submitted for 
receipt dates after October 1, 1998.

All investigators proposing research involving human subjects should read the 
"NIH Policy and Guidelines" on the inclusion of children as participants in 
research involving human subjects that is available at 
http://grants.nih.gov/grants/funding/children/children.htm. 

REQUIRED EDUCATION ON THE PROTECTION OF HUMAN SUBJECT PARTICIPANTS: NIH policy 
requires education on the protection of human subject participants for all 
investigators submitting NIH proposals for research involving human subjects.  
You will find this policy announcement in the NIH Guide for Grants and 
Contracts Announcement, dated June 5, 2000, at 
http://grants.nih.gov/grants/guide/notice-files/NOT-OD-00-039.html.

PUBLIC ACCESS TO RESEARCH DATA THROUGH THE FREEDOM OF INFORMATION ACT: The 
Office of Management and Budget (OMB) Circular A-110 has been revised to 
provide public access to research data through the Freedom of Information Act 
(FOIA) under some circumstances.  Data that are (1) first produced in a 
project that is supported in whole or in part with Federal funds and (2) cited 
publicly and officially by a Federal agency in support of an action that has 
the force and effect of law (i.e., a regulation) may be accessed through FOIA.  
It is important for applicants to understand the basic scope of this 
amendment.  NIH has provided guidance at 
http://grants.nih.gov/grants/policy/a110/a110_guidance_dec1999.htm.

Applicants may wish to place data collected under this RFA in a public 
archive, which can provide protections for the data and manage the 
distribution for an indefinite period of time.  If so, the application should 
include a description of the archiving plan in the study design and include 
information about this in the budget justification section of the 
application. In addition, applicants should think about how to structure 
informed consent statements and other human subjects procedures given the 
potential for wider use of data collected under this award.

URLs IN NIH GRANT APPLICATIONS OR APPENDICES:  All applications and proposals 
for NIH funding must be self-contained within specified page limitations. 
Unless otherwise specified in an NIH solicitation, Internet addresses (URLs) 
should not be used to provide information necessary to the review because 
reviewers are under no obligation to view the Internet sites.  Furthermore, we 
caution reviewers that their anonymity may be compromised when they directly 
access an Internet site.

HEALTHY PEOPLE 2010: The Public Health Service (PHS) is committed to achieving 
the health promotion and disease prevention objectives of "Healthy People 
2010," a PHS-led national activity for setting priority areas. This RFA is 
related to one or more of the priority areas. Potential applicants may obtain 
a copy of "Healthy People 2010" at http://www.health.gov/healthypeople.

AUTHORITY AND REGULATIONS:  This program is described in the Catalog of 
Federal Domestic Assistance No. 93.989.  Awards are made under authorization 
of sections 301 and 405 of the Public Health Service Act as amended (42 USC 
241 and 284) and administered under NIH grants policies and Federal 
Regulations 42 CFR 52 and 45 CFR Parts 74 and 92.  This program is not 
subject to the intergovernmental review requirements of Executive Order 12372 
or Health Systems Agency review. 
The PHS strongly encourages all grant recipients to provide a smoke-free 
workplace and discourage the use of all tobacco products.  In addition, 
Public Law 103-227, the Pro-Children Act of 1994, prohibits smoking in 
certain facilities (or in some cases, any portion of a facility) in which 
regular or routine education, library, day care, health care, or early 
childhood development services are provided to children.  This is consistent 
with the PHS mission to protect and advance the physical and mental health of 
the American people.

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