Project Summary Labor migration is a major contributor to fueling the global AIDS epidemic and also the movement of HIV across country borders and populations. Migrants who inject drugs while in a host country are at especially high risk. Tajikistan, a small country in Central Asia, exports more than a million temporary labor migrants annually, many of whom inject drugs. These migrants are highly subject to the negative effects of intersectional stigma within Russia's cultural and socio-economic environment due to being both a migrant worker and a person who injects drugs (PWID). In addition, they are subject to extensive censure and marginalization from their non-drug-using Tajik peers in the close-knit diaspora communities in which they reside, especially if they acquire HIV. The adverse effects of stigmatization on those who experience it are well documented. The intersection of stigmatized identities as migrants and people who inject drugs (PWID), along with stigma associated with HIV infection, contributes to HIV risk behavior, poses as a barrier to accessing HIV testing and other prevention/treatment services, and results in poorer health outcomes for those living with HIV. The proposed study will investigate the character of stigma in the Moscow Tajik migrant community, and the effects of multiple intersecting forms of stigma on the health and well-being of Tajik labor migrants who inject drugs while living in Moscow (Aim 1). We will use the insight and findings gained through this formative research to develop an innovative intervention specifically designed to counter the negative effects of drug- related stigma within the Tajik migrant community that can affect HIV risk behavior and prevention among Tajik migrants in Moscow who inject drugs (Aim 2). The Stigma Reduction Intervention Approach Via Leaders of Diaspora (SRI-AVLOD) intervention will draw on the strengths of close-knit Tajik diaspora communities in which new norms and behaviors can be effectively diffused and promoted within and across migrant social networks if endorsed by leaders whom they trust. SRI-AVLOD is designed to recruit and train Tajik diaspora community leaders as agents of change and open up conversation within the Moscow Tajik community about the effects of drug and HIV-related stigma, to reduce stigmatizing beliefs and actions that negatively affect HIV risk behavior and prevention among community members who inject drugs. After developing a working prototype, we will deliver the intervention to small groups of Tajik migrant community leaders to assess its feasibility and acceptability, and need for further modifications (Aim 3). In future work we will deliver and test the efficacy of the SRI-AVLOD model in changing drug-related stigma and stigmatizing beliefs, behavior, and consequences at all levels (community, leadership, PWID) within the Tajik diaspora community and its positive effects in reducing HIV risk behavior and increasing the adoption of HIV prevention methods and services among its Tajik members who inject drugs.

Project Narrative Temporary labor migrants who inject drugs are at exceptionally high risk for acquiring HIV and transmitting it between country borders. Intersectional stigma associated with migrant status, illicit drug use, and HIV promotes risky behavior and inhibits preventative action. Interventions to reduce stigma would potentially contribute to reductions in HIV transmission and acquisition in this population.