ESCALATE: Ending Stigma through Collaboration and Lifting All to Empowerment


“ESCALATE” (Ending Stigma through Collaboration And Lifting All To Empowerment) is a first-of-its kind training and capacity-building initiative specifically designed to address HIV-related stigma that creates barriers at multiple levels of the HIV care continuum.

NMAC created ESCALATE to reflect its mission and relationship to the communities of people with HIV. NMAC “leads with race” as the burdens of the HIV/AIDS epidemic are most deeply felt in racial and ethnic minority communities. HIV stigma reflects these structural inequities and amplifies the multiple stigmas experienced by communities impacted by HIV based on their race, ethnicity, sexual orientation, gender identity, social status, mental health and substance use, and relationship to sex work or incarceration. Only by viewing HIV stigma through these multiple lenses can we address its deep and insidious impacts.

To meet the goals of ESCALATE, NMAC has partnered with Abt Associates (Abt), TRX Development Solutions (TRX), and NORC at the University of Chicago (NORC).

The Challenge

ESCALATE works across multiple levels of the Ending the HIV Epidemic in the U.S. (EHE) initiative and the HIV National Strategic Plan (HIV Plan) to address internalized and externalized HIV-related stigma within the Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB) Ryan White HIV/AIDS Program (RWHAP):

Pillars of the EHE Initiative HIV Plan 2021 Goals ESCALATE Activities



Goal 1: Prevent New HIV Infections ESCALATE activities indirectly enhance existing prevention efforts. RWHAP providers and systems that are aware of the impact of HIV-related stigma and are trained in stigma-reduction strategies will be better equipped to have conversations with individuals and communities about harm reduction strategies, destigmatize testing and diagnosis, and more consistently prescribe pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). 
Treat Goal 2: Improve HIV-Related Health Outcomes of People with HIV ESCALATE Training infuses the RWHAP system with approximately 1,200 individuals trained in stigma-reduction practices to proactively eliminate stigma at RWHAP agencies. 
Treat Goal 3: Reduce HIV-Related Disparities and Health Inequities  ESCALATE Technical Assistance (TA) builds support for organizational embrace of practices that reduce HIV stigma and other intersectional forms of stigma experienced by the communities that are most deeply impacted by the HIV epidemic. Because HIV stigma is deeply associated with barriers to diagnosis, engagement, and retention in care, reducing its impact should, in the long-term, reduce demographic and other disparities across the HIV continuum of care. TA will reach up to 150 RWHAP agencies, creating a critical threshold of RWHAP professionals, providers, and community members engaging in stigma reduction and providing models for other agencies to do so.
Treat Goal 4: Achieve Integrated, Coordinated Efforts that Address the HIV Epidemic among All Partners and Stakeholders ESCALATE Learning Collaboratives (LCs) bring together RWHAP agencies from across the program parts to build practices and supports for cultural responsiveness and humility that can be disseminated throughout the RWHAP system.
Respond   ESCALATE activities will not directly impact this pillar.

Focus Population

Through participation in training, TA, and LCs, Stigma Reduction Teams will support people with HIV in urban, rural, and native communities; Ryan White Care Providers, Planning Councils, in urban, rural, and Native communities, with a special focus on transgender/gender non-conforming individuals, men who have sex with men, and the Black/African-American community.

The Model

ESCALATE provides a three-component program to mitigate and eliminate stigma in HIV-related service provision in the United States.

  • New and Innovative Training: Training is designed to reduce HIV-related stigma through evidence-informed interventions and strategies with an emphasis on cultural humility for HIV service systems, organizations, and individuals. Training is designed to meet the needs of individual RWHAP care providers (e.g., clinicians, administrators, patient navigators) who acknowledge the impact of HIV-related stigma on their client populations and communities. These individuals are ready to create change but may not have the organizational capacity needed to create change across their clinical setting.

    Learn More and Apply for ESCALATE Training

  • Technical Assistance (TA):  ESCALATE will provide tailored TA to individual organizations by assessing TA needs, aligning TA activities and learning opportunities to those needs, and assessing the impact of TA on organizational behavior and change. TA participants will be matched with TA Coaches and Subject Matter Experts to address organization-specific goals through intensive 1:1 TA.

    Learn more and apply for ESCALATE Technical Assistance

  • Learning Collaboratives (LC):  ESCALATE will implement two LCs with RWHAP recipients/sub-recipients to address  HIV stigma experienced by their staff and clients. The first LC (LC1) will run from July 2021 to August 2022 with eight (8) organizations implementing stigma-reduction initiatives. LC1 members will participate in a multi-session, facilitated Learning Collaborative focused on stigma and cultural humility. LC1 members will have the opportunity to test adaptations to evidence-based stigma-reduction strategies, tools, and practices as well as learn from subject matter experts and peers implementing similar stigma-reduction initiatives with similar populations of focus.

    Learn more and apply for the ESCALATE Learning Collaborative


  • NMAC: Training
  • Abt Associates: Technical Assistance
  • NORC at the University of Chicago: Learning Collaborative
  • TRX Development: Project Evaluation

ESCALATE is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) and the Minority HIV/AIDS Fund as part of a financial assistance award totaling $1,600,906.100 percentage funded by HRSA/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA/HHS, or the U.S. Government.

Contact Information

Project Contacts:

Paul Kawata
Alexis Marbach, MPH, PMP
Co-PI, Abt Associates
Abt Associates
Charles Shazor
Project Manager
Niki Reddy
Project Manager, Abt Associates
Abt Associates

HRSA Contacts:

PO Name
LaQuanta P. Smalley, MPH, BSN, RN, CPN
PO Title
Nurse Consultant – Clinical & Quality Branch
PO Phone
(301) 443-0995


Funding Mechanism: Cooperative Agreement

Recipient Organization: NMAC

Grant number: U69HA39335

Project Period: 9/1/2020 - 8/31/2024