May 22, 2023
National Institute of Mental Health (NIMH)
The purpose of this Notice is to call for research to understand and address the impact of HIV-related intersectional stigma and discrimination (ISD), or other social and structural determinants of health (SSDOH) as they relate to HIV prevention and treatment. This NOSI is a reissue of NOT-MH-20-020.
Public health researchers, providers, and community members have long recognized that, despite HIV scientific advances, HIV-related stigma and discrimination continue to be critical barriers to the uptake of evidence-based HIV prevention and treatment. Stigma is a multi-level problem that manifests at the individual, interpersonal, and structural levels. Systems of oppression (e.g., racism, classism, sexism, homophobia, and transphobia) are also intersecting drivers of stigma and discrimination among people with and without HIV -- leading researchers to apply an intersectionality analytic framework (rooted in Black feminist critical theory) to assess these interlocking systems of disadvantage and the experiences of marginalized communities. Intersectional stigma and discrimination (ISD) can negatively affect the health and well-being of people living with HIV (PLWH) by discouraging them from learning their HIV status, linking and accessing antiretroviral therapy (ART), adhering to ART to achieve durable viral suppression, and staying engaged in care. ISD can also negatively affect people from high-incidence populations by discouraging them from seeking HIV testing, linking and accessing HIV prevention tools (e.g., pre-exposure prophylaxis or PrEP), adhering to and persisting with biomedical HIV prevention such as PrEP, and talking openly with partners about HIV prevention strategies. HIV-related ISD is prevalent among key populations such as minority women living with HIV, as well as men who have sex with men and other sexual and gender minority groups, particularly those who are young, minority and living in the Southern region of the U.S., in Sub-Saharan Africa or in other Low and Middle-Income Countries (LMICs). However, because HIV-related ISD manifests differently across cultural contexts and social settings, it is important to target those at substantial risk of poor outcomes in HIV prevention or treatment and take a multidimensional and multilevel approach to understand how ISD impacts outcomes to inform and test ISD-reduction approaches. An intersectionality lens can also inspire a strengths-based approach to challenge systems of oppression, empower collective action, leverage community resources, and build resiliencies to improve multilevel outcomes.
More than three decades into the HIV epidemic, the SSDOH are increasingly understood as key contributors to patterns of high HIV incidence and prevalence. SSDOH are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning and quality-of-life outcomes and risks. The Healthy People 2030 initiative (https://health.gov/healthypeople) has organized SDOH into the following domains: 1) economic stability, 2) education access and quality, 3) healthcare access and quality, 4) neighborhood and built environment, and 5) social and community context. Social-structural factors related to HIV outcomes, however, do not affect everyone equally. Applying an intersectional lens to SSDOH, sometimes referred to as intersectional social-structural factors or intersectional insecurities, allows examination not only at the intersection of multiple marginalized positions, but also at the intersections of different social processes. Many communities substantially impacted by HIV face multiple insecurities, such as economic inequality, race inequality, stigma and discrimination, unstable housing, lack of transportation, limited or uncertain access to food, and/or inadequate access to health services. It is critical to apply an intersectional framework to understand how multiple disadvantages (and structures of oppression) interact to produce differences between different population groups. These intersectional social-structural factors impact efforts in HIV testing and diagnosis, linkage and access to HIV prevention or care, adherence and persistence to PrEP or ART, and HIV viral suppression (for people living with HIV).
There is a need to move beyond cross-sectional studies that focus on one type of stigma or discrimination, or one social-structural determinant by advancing intersectional approaches to understand the mechanisms and pathways by which ISD or SSDOH are interrelated and interact to impact HIV prevention or treatment outcomes. There is a specific interest in understanding mutable mechanisms by which ISD or intersectional social-structural factors exert their effects, at multiple levels that could be targeted for intervention. The field would also benefit from a greater understanding of protective factors and resilience, particularly why some individuals, despite facing intersectional stigma or discrimination and living in highly disadvantaged environments, are able to maintain their health. Research that characterizes the social and structural conditions (e.g., culture, community organization) which facilitate resilience is particularly encouraged. Filling these research gaps is fundamental to the development of effective structural and/or multi-level interventions to prevent HIV and improve HIV care outcomes.
This NOSI solicits theoretically- and empirically-driven research applications which will: 1) advance measurements and understanding of HIV-related ISD or intersectional social-structural factors to examine the mechanisms and pathways by which they are barriers to HIV prevention and HIV treatment; 2) develop and test interventions to address their impact to improve HIV prevention and HIV treatment outcomes; or 3) conduct implementation science research of evidence-based interventions.
Areas of Research Interest
While the areas of ISD and SSDOH are vast, it is expected that some may be more amenable to HIV-related research questions than others. Therefore, applicants in collaboration with their relevant communities and stakeholders should carefully consider their research aims in determining which ISD or SSDOH they propose to examine. Proposed research must be in the context of their impact on HIV prevention or treatment outcomes.
Specific areas of research interest may include, but are not limited to:
Applicants are strongly encouraged to adopt a community-centered approach to engage communities most impacted by HIV-related ISD or intersectional social-structural determinants. Given the importance of incorporating input throughout the entire research process, the inclusion and input of a community advisory board in the conceptualization, design, conduct, analysis and publication is a minimum requirement required for all submissions to this Notice.
It is strongly recommended that applicants review the NIMH Division of AIDS Research current Notice of Funding Opportunities (available on our website at https://www.nimh.nih.gov/about/organization/dar/aids-related-funding-opportunity-announcements-foas) and consult with a Program Officer before application submission.
Application and Submission Information
This notice applies to due dates on or after September 7, 2023 and subsequent receipt dates through September 8, 2026.
Submit applications for this initiative using one of the following Notices of Funding Opportunity announcements (NOFOs) or any reissues of these announcement through the expiration date of this notice.
PAR-23-062, Innovations to Optimize HIV Prevention and Care Continuum Outcomes (R01 Clinical Trial Optional)
PAR-23-061, Innovations to Optimize HIV Prevention and Care Continuum Outcomes (R21 Clinical Trial Optional)
PAR-23-060, Formative and Pilot Intervention Research to Optimize HIV Prevention and Care Continuum Outcomes (R34 Clinical Trial Optional)
PA-20-190, Mentored Research Scientist Development Award (Parent K01--Independent Clinical Trial Not Allowed)
PA-20-176, Mentored Research Scientist Development Award (Parent K01-Independent Clinical Trial Required)
PA-20-202, Mentored Clinical Scientist Research Career Development Award (Parent K08 Independent Clinical Trial Required)
PA-20-203, Mentored Clinical Scientist Research Career Development Award (Parent K08 Independent Clinical Trial Not Allowed)
PA-20-206, Mentored Patient-Oriented Research Career Development Award (Parent K23 Independent Clinical Trial Required)
PA-20-205, Mentored Patient-Oriented Research Career Development Award (Parent K23 Independent Clinical Trial Not Allowed)
PA-20-200, NIH Small Research Grant Program (Parent R03 Clinical Trial Not Allowed)
PA-20-187, NIH Pathway to Independence Award (Parent K99/R00 Independent Clinical Trial Required)
PA-20-188, NIH Pathway to Independence Award (Parent K99/R00 Independent Clinical Trial Not Allowed)
PA-20-193, Midcareer Investigator Award in Patient-Oriented Research (Parent K24 Independent Clinical Trial Required)
PA-20-186, Midcareer Investigator Award in Patient-Oriented Research (Parent K24 Independent Clinical Trial Not Allowed)
PAR-21-251, Emerging Global Leader Award (K43 Independent Clinical Trial Required)
PAR-21-252, Emerging Global Leader Award (K43 Independent Clinical Trial Not Allowed)
PAR-21-228, NIMH Research Education Mentoring Program for HIV/AIDS Researchers (R25 Clinical Trial Not Allowed)
PAR-21-155, Academic Research Enhancement Award for Undergraduate-Focused Institutions (R15 Clinical Trial Not Allowed)
PAR-21-154, Academic Research Enhancement Award for Undergraduate-Focused Institutions (R15 Clinical Trial Required)
PAR-22-060, Research Enhancement Award Program (REAP) for Health Professional Schools and Graduate Schools (R15 Clinical Trial Not Allowed)
PAR-21-357, Research Enhancement Award Program (REAP) for Health Professional Schools and Graduate Schools (R15 Clinical Trial Required)
PA-21-050, Ruth L. Kirschstein National Research Service Award (NRSA) Individual Fellowship for Students at Institutions Without NIH-Funded Institutional Predoctoral Dual-Degree Training Programs (Parent F30)
PA-21-051, Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship (Parent F31)
PA-21-052, Ruth L. Kirschstein National Research Service Award (NRSA) Individual Predoctoral Fellowship to Promote Diversity in Health-Related Research (Parent F31-Diversity)
PA-21-048, Ruth L. Kirschstein National Research Service Award (NRSA) Individual Postdoctoral Fellowship (Parent F32)
PA-23-048, Ruth L. Kirschstein National Research Service Award (NRSA) Institutional Research Training Grant (Parent T32)
All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:
Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.
Please direct all inquiries to the contacts in Section VII of the listed notice of funding opportunity with the following additions/substitutions: