Acceptance and Commitment to Empowerment Intervention to Reduce HIV Stigma and Promote Community Resilience: Protocol for an Implementation Study.

Background: Racialized immigrants are disproportionately impacted by HIV in Canada. In 2022, 69.5% of first-time HIV cases, where race and/or ethnicity was reported, were among racialized individuals: Indigenous (22.6%), Black (18.0%), Asian and Arab (16.3%), and Latinx (10.1%). HIV vulnerability in racialized communities is reinforced by HIV stigma intersecting with prejudice and discrimination associated with racism, gendered oppression, homophobia, and economic marginalization. Stigma and discrimination impede public health efforts in HIV prevention, testing, treatment, and care. Objective: The goal of the study is to reduce HIV-related stigma in racialized immigrant communities in 6 Canadian cities in Alberta (Calgary, Edmonton) and Ontario (London, Niagara, Ottawa, Toronto). We will implement an evidence-based 6-session online intervention, Acceptance and Commitment to Empowerment (ACE), to promote skills for psychological flexibility (mindfulness, acceptance, cognitive defusion, values clarification, and committed action) and collective empowerment (critical reflection, dialogue, interconnectedness, and collective action). The objectives are to (1) assess community contexts and needs to inform the refinement of ACE; (2) build community capacity in stigma reduction; (3) evaluate the facilitators and barriers of implementing stigma reduction programs; and (4) disseminate knowledge to advance research, policy, and practice. Methods: Guided by the principles of social justice and health equity, we will apply the context-based PRISM (Practical Robust Implementation and Sustainability Model) and outcome-based RE-AIM (reach, effectiveness, adoption, implementation, maintenance) frameworks to inform the contextual adaptation, implementation, and evaluation of the ACE intervention. In phase 1 (year 1), we aim to survey 12 local organizations on their existing stigma reduction programs; engage 30 service providers and 60 community members to explore the local contexts and needs of stigma reduction. In phase 2 (year 2), phase 1 results will be used to refine the ACE intervention and apply a train-the-trainer (TTT) approach to engage 48 service providers or community leaders in the ACE training. ACE TTT graduates will be mentored to become ACE Community Facilitators. In phase 3 (years 3-4), project staff and ACE Community Facilitators will work in small 3-member teams to deliver the online ACE intervention to qualified participants (n=288) in 6 cities. Mixed methods will be used to examine the contextual factors on implementation processes and intervention effectiveness. Data analyses will include reflexive thematic analysis of qualitative data, inferential statistics, and analyses of variance to determine the effectiveness of the intervention over time. Results: The implementation of project ACE was delayed by 2 years due to the COVID-19 pandemic. The requirement of obtaining research ethics approvals from all affiliated universities (n=8) further delayed the launch of research activities involving participants until September 2023. Between October 2023 and August 2024, the project team recruited 8 community leaders from the 6 project sites to form the Project Advisory Committee (PAC), worked with PAC members to identify outreach and recruitment strategies for phase 1, and recruited and secured 19 community organizations as project collaborators for phase 2. As of March 2025, phase 1 data collection has been completed, and data analysis and knowledge translation are underway. Conclusions: Based on results from previous research, we anticipate generating critical knowledge on the effectiveness of ACE in reducing internalized and enacted stigma through collective empowerment, and the facilitators/barriers in implementing ACE among racialized immigrants in real-world settings.