NIH grant: Two-Spirit and Indigenous LGBTQ+ Aging with HIV (1R36AG090791-01A1)

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NIH grant 1R36AG090791-01A1: Two-Spirit and Indigenous LGBTQ+ Aging with HIV
Institute: {'code': 'AG', 'abbreviation': 'NIA', 'name': 'National Institute on Aging', 'admin_org_id': '12500002', 'admin_funding_url': ''}. PI: Chase  Bryer. Award: $69456.
Start: 2026-08-01T00:00:00.
SUMMARY
Background: Two-Spirit and Indigenous LGBTQ+ individuals in the U.S. and Canada face elevated rates of
HIV/AIDS and associated health disparities. Advancements in HIV treatment have led to a notable increase in
Indigenous 2S/LGBTQ+ people living with HIV (PLWH), highlighting the need for culturally sensitive long-term
care strategies for older adults and Indigenous Elders. However, mainstream concepts of 'successful aging'
often neglect the unique challenges of Indigenous 2S/LGBTQ+ people aging with HIV (e.g. intersectional
stigma, historical trauma). This underscores the importance of integrating their perspectives into
comprehensive models of aging. Moreover, fostering Indigenous cultural generativity is recognized as crucial
for aging well among Indigenous Elders. This study aims to gather insights into aging trajectories and
Indigenous cultural generativity among Indigenous 2S/LGBTQ+ populations living with HIV in urban inter-tribal
regions across the U.S. and Canada. By examining aging trajectories, healthy aging indicators, and Indigenous
cultural generativity within these communities, we aim to deepen understanding of intersectional health
disparities, informing culturally appropriate interventions such as intergenerational healing workshops that may
be leveraged to promote health and wellness among Indigenous 2S/LGBTQ+ PLWH. Environment: The study
benefits from an established research collaboration between the PI’s mentors, Drs. Proulx and Lewis, who are
Indigenous, co-mentor Dr. Melissa Clark, and Senior Biostatistician Mr. Christopher Santostefano. Additionally,
the project will be supported by close partnerships with community organizations (e.g., the Two-Spirit Dry Lab,
the Paths (Re)Membered Project). A Community Advisory Board (CAB) comprising Indigenous activists and
HIV experts will also provide crucial guidance on ensuring cultural sensitivity in research approaches.
Approach: This study seeks to understand how various aging trajectories manifest among Indigenous
2S/LGBTQ+ individuals living with HIV and how the intersectionality of their identities influences aging paths
with HIV. It also explores the influence of culturally grounded healthy aging indicators on Indigenous cultural
generativity through a secondary data analysis. To this end, we propose to: (1) To quantitatively explore
healthy aging indicators and Indigenous cultural generativity among a subset of Indigenous 2S/LGBTQ with
and without HIV (n=447); and (2) To conduct in-depth interviews with between 15-20 Indigenous 2S/LGBTQ+
PLWH to illicit perspectives on aging trajectories and what it means to age well to understand how participants
make sense of their experiences and the world by interpreting the stories they tell. The findings from this R36
dissertation award will deepen our understanding of intersectional health disparities and provide preliminary
data to support the submission of a larger NIH grant to design and pilot test an adaptive, multi-component
(e.g., intergenerational cultural healing, resilience coping, mindfulness) intervention to improve HIV care
continuum outcomes among Indigenous 2S/LGBTQ+ PLWH such as those in long-term care settings.

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