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AbstractIntroductionBecause transgender individuals experience disproportionately high rates of HIV infection, this population is an increasing focus of epidemiological and implementation science research to combat the epidemic. However, study participants, providers and other advocates have become increasingly concerned about research practices that may alienate, objectify, exploit or even re‐traumatize the communities they are designed to benefit. This commentary explores the common pitfalls of HIV research with transgender communities and provides a potential framework for ethical, community‐engaged research practice.DiscussionWe review some of the critical challenges to HIV research with transgender and non‐binary communities that limit the potential for such studies to improve practice. For example, scales that measure stigma perceptions/experiences often include activating language, while the consistent focus in research on risk and trauma can often feel judgemental and redundant. Because of limited employment opportunities, some participants may feel undue influence by research stipends; others may perceive their participation as fuelling the larger research economy without providing research jobs to community members. Questions remain regarding optimal strategies for authentic research partnership beyond community advisory boards or focus groups. Transgender and non‐binary researchers are under‐represented and may be tokenized. Many demonstration projects provide much‐needed services that disappear when the research funding is over, and community‐based dissemination efforts are often perceived as "too little, too late" to effect change.ConclusionsBased on this review and input from study participants across the United States, we detail six recommendations for ethical HIV research with transgender and non‐binary communities, including (1) equitable budgeting with community‐based programme partners; (2) representation in the development of both research agenda and methods; (3) integration of research activities into the ongoing work of any clinical or service site, so that individuals' needs as "clients" can continue to be prioritized over their role as "participants;" (4) mindfully considered compensation that values the contributions of community members, but avoids undue influence; (5) transparent, community‐focused and timely communication at every stage of the study, including research purpose, data usage, preliminary findings and full‐scale results; and (6) planning for sustainability of any programme or services beyond the life of the research project.

AbstractIntroductionThere is robust evidence that stigma negatively impacts both people living with HIV and those who might benefit from HIV prevention interventions. Within healthcare settings, research on HIV stigma has focused on intra‐personal processes (i.e. knowledge or internalization of community‐level stigma that might limit clients' engagement in care) or inter‐personal processes (i.e. stigmatized interactions with service providers). Intersectional approaches to stigma call us to examine the ways that intersecting systems of power and oppression produce stigma not only at the individual and interpersonal levels, but also within healthcare service delivery systems. This commentary argues for the importance of analysing and disrupting the way in which stigma may be (intentionally or unintentionally) enacted and sustained within HIV service implementation, that is the policies, protocols and strategies used to deliver HIV prevention and care. We contend that as HIV researchers and practitioners, we have failed to fully specify or examine the mechanisms through which HIV service implementation itself may reinforce stigma and perpetuate inequity.DiscussionWe apply Link and Phelan's five stigma components (labelling, stereotyping, separation, status loss and discrimination) as a framework for analysing the way in which stigma manifests in existing service implementation and for evaluating new HIV implementation strategies. We present three examples of common HIV service implementation strategies and consider their potential to activate stigma components, with particular attention to how our understanding of these dynamics can be enhanced and expanded by the application of intersectional perspectives. We then provide a set of sample questions that can be used to develop and test novel implementation strategies designed to mitigate against HIV‐specific and intersectional stigma.ConclusionsThis commentary is a theory‐informed call to action for the assessment of existing HIV service implementation, for the development of new stigma‐reducing implementation strategies and for the explicit inclusion of stigma reduction as a core outcome in implementation research and evaluation. We argue that these strategies have the potential to make critical contributions to our ability to address many system‐level form stigmas that undermine health and wellbeing for people living with HIV and those in need of HIV prevention services.