Reducing Stigma to Improve HIV/AIDS Prevention, Treatment and Care in Low and Middle- Income Countries (R21) | PAR 17 474

Opportunity Information: Apply for PAR 17 474

The National Institutes of Health (NIH) funding opportunity announcement PAR-17-474, titled "Reducing Stigma to Improve HIV/AIDS Prevention, Treatment and Care in Low and Middle-Income Countries (R21)," supports exploratory and early-stage research focused on reducing HIV/AIDS-related stigma in low- and middle-income countries (LMICs). The central idea behind the program is that stigma remains a major, persistent barrier to HIV prevention and to the full continuum of HIV care, including testing, linkage to care, treatment initiation, long-term retention, and overall quality of life for people living with HIV/AIDS (PLWH). Through this R21 mechanism, NIH is aiming to encourage innovative, proof-of-concept projects that can test feasible approaches, generate preliminary evidence, and set the stage for larger-scale intervention research.

The opportunity is specifically designed to stimulate intervention research rather than purely descriptive studies. Projects are expected to focus on actionable strategies that reduce stigma and demonstrate why that reduction matters for health outcomes and public health impact. The announcement emphasizes that stigma is not only a social harm but also a driver of HIV transmission and poor treatment outcomes, because it can discourage people from seeking testing, disclosing status, accessing prevention tools, attending clinics, adhering to antiretroviral therapy, or staying engaged in care. Therefore, applicants are encouraged to connect stigma reduction to measurable changes such as increased care-seeking behavior, improved treatment uptake or adherence, better retention in care, and potentially reduced HIV transmission risk.

NIH outlines several priority research areas for this call. One major area is the development and testing of novel stigma-reduction interventions that explicitly link stigma reduction to improved HIV-related behaviors and outcomes, such as earlier testing, improved linkage to care, or reduced risk behaviors that contribute to transmission. Another priority is reducing the impact of stigma on adolescents and/or youth, recognizing that young people often face distinct vulnerabilities, including heightened concerns about confidentiality, discrimination in schools or communities, and barriers to youth-friendly health services. The FOA also highlights the need to address layered or intersecting stigma, especially the complex burden experienced by individuals living with HIV alongside other comorbidities or coinfections. In many LMIC settings, HIV stigma can overlap with stigma tied to tuberculosis, viral hepatitis, mental health conditions, substance use, or other socially marginalized identities and health issues, creating compounded barriers to prevention and care.

The announcement further encourages research that targets stigma affecting family members or caregivers of PLWH, or stigma that may be enacted by family systems and caregiving networks. This reflects an understanding that HIV stigma can extend beyond the person diagnosed and can influence household dynamics, caregiving quality, social support, and willingness to engage with health services. Another key emphasis is improved stigma measurement, particularly measurement approaches that are innovative and suited for use within intervention implementation. This could include developing or refining tools that better capture changes in stigma over time, distinguish different stigma domains (such as internalized, anticipated, perceived, or enacted stigma), and work reliably across cultures and contexts commonly encountered in LMIC research. Measurement is treated as a practical need, because weak or inappropriate measures can make it difficult to tell whether an intervention is working or why results may vary by setting.

The broader goals of the FOA are to deepen understanding of how stigma reduction can serve as a lever to reduce HIV transmission, to eliminate or mitigate stigma-related barriers that limit beneficial health outcomes for people who are infected or at risk, and to launch exploratory studies that establish feasibility for interventions in real-world LMIC conditions. Because this is an R21 opportunity, it is oriented toward early-stage, high-potential ideas and feasibility testing rather than large, definitive clinical trials. Typical outcomes of an R21 under this kind of program might include pilot data, refined intervention models, tested recruitment and retention strategies, evidence of acceptability and practicality in a specific setting, and stronger measures for assessing stigma and related outcomes.

In terms of eligibility, the FOA is broadly open to a range of organization types, including public and state-controlled institutions of higher education, private institutions of higher education, nonprofit organizations (both with and without 501(c)(3) status), and other eligible entities. It also explicitly notes additional eligible applicant categories such as Historically Black Colleges and Universities (HBCUs), Hispanic-serving Institutions, Tribally Controlled Colleges and Universities (TCCUs), Alaska Native and Native Hawaiian Serving Institutions, and Asian American Native American Pacific Islander Serving Institutions (AANAPISISs). Importantly, non-domestic (non-U.S.) entities, including foreign organizations, are eligible, which fits the LMIC focus and encourages leadership and partnership from institutions based in the countries where interventions will be studied.

The opportunity falls under the NIH grant funding instrument and the health funding activity category, with CFDA numbers 93.242 and 93.989. The source details list an award ceiling of $125,000 and an original closing date of December 11, 2017, indicating that this specific posting was time-bounded; however, the scientific priorities and structure described reflect a broader NIH interest in stigma as a modifiable determinant of HIV outcomes. Overall, the FOA is centered on practical, culturally grounded intervention research that can show whether reducing HIV-related stigma in LMIC settings leads to meaningful improvements in prevention, treatment engagement, and the lived experience and well-being of people affected by HIV.

• The National Institutes of Health in the health sector is offering a public funding opportunity titled "Reducing Stigma to Improve HIV/AIDS Prevention, Treatment and Care in Low and Middle- Income Countries (R21)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.242, 93.989.
• This funding opportunity was created on 2017-09-01.
• Applicants must submit their applications by 2017-12-11. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $125,000.00 in funding.
• Eligible applicants include: Public and State controlled institutions of higher education, Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, Others.

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