Addressing Sexuality- and HIV-Related Stigma Among Indigenous Traditional Healers and Indigenous GBM: Preliminary Findings from the Kawabil Trial

Background and Purpose. Indigenous gay and bisexual men (IGBM) in Guatemala experience intersecting stigmas related to sexuality, HIV, and Indigenous identity. Discrimination within formal health systems exacerbates inequities in care access, positioning Indigenous Traditional Healers (ITH) as the primary and most trusted providers of physical and mental health services. Reducing stigma within this provider group is therefore critical for improving health access and outcomes for IGBM. This study presents preliminary findings from KAWABIL, a culturally adapted stigma‑reduction intervention designed for ITH in the Guatemalan highlands.

Methods. A wait‑list control trial was conducted with 154 participants (87 IGBM; 67 ITH), assigned to either an immediate intervention arm (n=65) or a wait‑list arm (n=89). All participants completed baseline, 1‑week, and 3‑month assessments; this analysis draws on baseline and 1‑week data. KAWABIL aimed to reduce sexuality‑ and HIV‑related stigma among ITH and IGBM through culturally grounded training and facilitated dialogue.

Results. ITH who received the KAWABIL intervention, demonstrated significant reductions in stigmatizing attitudes toward both IGBM and people living with HIV (PLWH). From baseline to 1‑week post‑intervention, the proportion of ITH feeling very comfortable with various social interactions with GBM increased significantly (p<0.05): renting a room (16% to 84%), working together (23% to 77%), having as a neighbor (32% to 68%), having GBM provide childcare (31% to 69%), having a relative marry a GBM (25% to 75%), introducing to friends (16% to 84%), and providing a job recommendation (25% to 75%). Similar improvements were observed for attitudes toward PLWH, including comfort with renting a room (36% to 64%), working together (37% to 63%), having as a neighbor (38% to 62%), having a PLWH provide childcare (38% to 63%), having a relative marry a PLWH (10% to 90%), introducing to friends (26% to 74%), and recommending for a job (24% to 76%).

Although not statistically significant, IGBM in the intervention arm showed meaningful shifts in internalized sexual stigma. From baseline to 1‑week, the proportion disagreeing with key items increased: “I’ve tried to stop being attracted to men” (44% to 56%), “I wish I weren’t gay/bisexual” (40% to 61%), and “I’ve tried to feel sexually attracted to women” (44% to 56%). IGBM also reported improved attitudes toward PLWH, including increased comfort with renting a room (42% to 59%), working together (45% to 55%), having as a neighbor (45% to 55%), receiving childcare (38% to 62%), having a relative marry a PLWH (42% to 58%), introducing to friends (44% to 56%), and recommending for a job (47% to 54%).

Conclusions and Implications. Preliminary evidence indicates that KAWABIL effectively reduces sexuality‑ and HIV‑related stigma among both ITH and IGBM. Rapid shifts in attitudes highlight the potential of culturally grounded, community‑driven interventions to address intersectional stigma and strengthen pathways to affirming care for Indigenous sexual minority populations. Ongoing follow‑up will assess the durability of these changes and their implications for HIV prevention and care engagement.