Participatory action research for change: collaborating with FSM youth to develop a multilevel intervention approach to HIV/STI prevention in guam

The National Institute of Allergy and Infectious Diseases awarded The Research Foundation for the State University of New York $399,250 on September 12, 2025, under the Allergy and Infectious Diseases Research program (CFDA 93.855) to conduct a four-year participatory action research study identifying factors that influence HIV and STI prevention and treatment among adolescents and young adults aged 15–24 from the Federated States of Micronesia living in Guam, and to design a multilevel intervention approach addressing structural barriers to care.

The research employs a participatory action research methodology in collaboration with two advocacy groups—Neechuumeres: Chuukese Women's Group of Guam and FSM Association—recognizing community participants as partners in developing research questions, designs, and dissemination strategies. The study engages the theory of structural vulnerability to address documented barriers including stigma, inequitable sexual relationships, lack of bodily autonomy, poverty, transportation access, limited healthcare system navigation ability, and medical racism within Guam's public healthcare system.

Work is performed in New York with a period of performance through August 31, 2029.

Abstract

People from the federated states of micronesia (FSM) who move to guam suffer disproportionately poor health outcomes, including high rates of HIV and stis. However, most stis are identified during prenatal care; thus, data are unreliable and likely underestimate actual community prevalence. This is particularly true for adolescents and young adults (AYA), aged 15-24, who are even less likely to seek care. Previous research determined that barriers to seeking HIV and STI prevention, testing, and treatment include stigma - both community-based and that imposed by outside actors; inequitable sexual relationships, and a lack of bodily autonomy; poverty, work and family obligations; limited ability to navigate the healthcare system; transportation access; and medical racism and bureaucratic disentitlement within guam's public healthcare system. All of these factors are mediated by the community tensions fostered by U.S. Management of immigration in guam. Micronesian communities have historically participated in shared decision-making models for community solutions. Participatory action research (PAR) is a model that works in such communities; IT recognizes community participants not just as givers of knowledge, but as producers and partners in the development of research questions, designs, distribution, and dissemination, and compliments already-established models of community decision-making. In collaboration with two advocacy groups who recognize these barriers to care: neechuumeres: chuukese women's group of guam and FSM association, the purpose of this exploratory study is to collaboratively identify factors that influence HIV and STI prevention and treatment among FSM diaspora AYA, and design an intervention using a PAR approach. Engaging with the theory of structural vulnerability, this 4-year, theory-engaged, community-driven mixed-methods research-to-action project has the following specific aims: (1): develop a community-based research partnership; train partners; conduct formative research on individual, community, and structural factors that shape HIV and STI prevention, testing, and treatment in FSM diaspora youth of guam; (2): collectively develop a multi-level theory-informed intervention to address these factors; and (3): test and evaluate the intervention, and adapt IT for expansion. This study will be the first of its kind to examine determinants and correlates of HIV and STI prevention through community-centered research in action-oriented migrant-focused organizations in the U.S. Territory of guam, where resources are limited due to its territorial status. IT will address an important health inequity issue in a guam community using a theory- based, mixed-methods collaborative approach, and lead to a community-centered intervention design. In accordance with R16 sure first grants, the PI will use the support to develop an extramurally funded research program at suny old westbury that involves undergraduate students, and use the findings to prepare an R21 to expand and test the intervention at a larger scale.