A pilot pragmatic trial of a "what matters most"-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana.
Ontology highlight
ABSTRACT:
SUBMITTER: Yang LH
PROVIDER: S-EPMC9219368 | biostudies-literature | 2022 Jun
REPOSITORIES: biostudies-literature
Publications
A pilot pragmatic trial of a "what matters most"-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana.
Yang Lawrence H LH Eschliman Evan L EL Mehta Haitisha H Misra Supriya S Poku Ohemaa B OB Entaile Patlo P Becker Timothy D TD Melese Tadele T Brooks Merrian J MJ Eisenberg Marlene M Stockton Melissa A MA Choe Karen K Tal Danielle D Li Tingyu T Go Vivian F VF Link Bruce G BG Rampa Shathani S Jackson Valerie W VW Manyeagae Gorata D GD Arscott-Mills Tonya T Goodman Melody M Opondo Philip R PR Ho-Foster Ari R AR Blank Michael B MB
AIDS research and therapy 20220623 1
We conducted a pilot trial of an intervention targeting intersectional stigma related to being pregnant and living with HIV while promoting capabilities for achieving 'respected motherhood' ('what matters most') in Botswana. A pragmatic design allocated participants to the intervention (N = 44) group and the treatment-as-usual (N = 15) group. An intent-to-treat, difference-in-difference analysis found the intervention group had significant decreases in HIV stigma (d = - 1.20; 95% CI - 1.99, - 0. ...[more]
Similar Datasets
Project description:BackgroundWith high rates of HIV and multiple vulnerable subgroups across diverse settings, there is a need for culturally based, HIV stigma reduction interventions. Pregnant women who are living with HIV are especially in need of services to protect not only their own but also their children's lives. Uptake of HIV services worldwide is hindered by stigma towards persons living with HIV/AIDS. While cultural context plays a key role in shaping HIV stigma, these insights have not yet been fully integrated into stigma reduction strategies. By utilizing the "What Matters Most" stigma framework, we propose that an intervention to counter culturally salient aspects of HIV stigma will improve treatment adherence and other relevant outcomes. A pragmatic clinical trial in Botswana will evaluate the "Mothers Moving towards Empowerment" (MME) intervention, which seeks to address HIV stigma in Botswana and to specifically engage pregnant mothers so as to promote antiretroviral therapy (ART) adherence in the postpartum period.MethodsThis study will test MME against treatment as usual (TAU) among pregnant mothers diagnosed with HIV and their infants. Outcomes will be assessed during pregnancy and 16 weeks postpartum. Women who meet eligibility criteria are assigned to MME or TAU. Women assigned to MME are grouped with others with similar estimated delivery dates, completing up to eight intervention group sessions scheduled before week 36 of their pregnancies. Primary outcomes among mothers include (i) reducing self-stigma, which is hypothesized to mediate improvements in (ii) psychological outcomes (quality of life, depression and social functioning), and (iii) adherence to antenatal care and ART. We will also examine a set of follow-up infant birth outcomes (APGAR score, preterm delivery, mortality (at < 16 weeks), birth weight, vaccination record, and HIV status).DiscussionOur trial will evaluate MME, a culturally based HIV stigma reduction intervention using the "What Matters Most" framework, to reduce stigma and improve treatment adherence among pregnant women and their infants. This study will help inform further refinement of MME and preparation for a future large-scale, multisite, randomized controlled trial (RCT) in Botswana.Trial registrationClinicalTrials.gov NCT03698981 . Registered on October 8, 2018.
| S-EPMC7542742 | biostudies-literature
Project description:Despite a comprehensive national program of free HIV services, men living with HIV in Botswana participate at lower rates and have worse outcomes than women. Directed content analysis of five focus groups (n = 38) and 50 in-depth interviews with men and women with known and unknown HIV status in Gaborone, Botswana in 2017 used the "what matters most" (WMM) and "structural vulnerability" frameworks to examine how the most valued cultural aspects of manhood interact with HIV-related stigma. WMM for manhood in Botswana included fulfilling male responsibilities by being a capable provider and maintaining social status. Being identified with HIV threatened WMM, which fear of employment discrimination could further exacerbate. Our findings indicate how cultural and structural forces interact to worsen or mitigate HIV-related stigma for urban men in Botswana. These threats to manhood deter HIV testing and treatment, but interventions could capitalize on cultural capabilities for manhood to promote stigma resistance.
| S-EPMC9287436 | biostudies-literature
Project description:HIV-related stigma is a barrier to engagement in care for young adults living with HIV. Other intersecting forms of stigma (e.g., racism, sexism, homophobia), may worsen HIV-related stigma and impact engagement in care. From November 2020 to February 2021, we conducted 20 in-depth qualitative interviews among young adults living with HIV attending a large, comprehensive HIV care center in Atlanta, Georgia. Semi-structured interview guides based on Earnshaw and Chaudoir's HIV Stigma Framework and the theory of intersectionality facilitated discussion around experiences with various forms of stigma and its possible influence on healthcare engagement. Using the social-ecological model, we used thematic analysis to contextualize how young adults living with HIV experienced intersectional stigma and enacted, anticipated, and internalized HIV stigma in both healthcare and non-healthcare settings. Most participants identified as male, Black/African American, and gay. Participants described stigma at intrapersonal, interpersonal, clinic, and community levels. Intrapersonal stigma was associated with delayed care seeking, isolation, and fear of disclosure. Interpersonal stigma included discrimination from family and friends and avoidance of close relationships to elude disclosure. At the clinic level, stigma included negative experiences with staff in HIV and non-HIV healthcare settings, which contributed to decreased engagement in care. Stigma in the community included differential treatment from employers, community leaders, and religious community and was associated with feelings of helplessness related to current societal inequalities. Coping/motivating mechanisms for stigma included prioritizing health, eliciting support from the medical care team and peers. Our findings show different intersecting stigmas are barriers to healthcare at multiple levels for young adults living with HIV, potentially exacerbating existing health and social disparities. To improve engagement in care among young adults living with HIV, future interventions should address the different mechanisms of stigma at community, clinic, interpersonal and intrapersonal levels by enhancing social support and improving healthcare structural competency.
| S-EPMC10414665 | biostudies-literature
Project description:We developed and pilot-tested an eight-session community-based cognitive behavior therapy group intervention to improve coping with intersectional stigma, address medical mistrust, and improve antiretroviral treatment adherence. Seventy-six HIV-positive Latinx sexual minority men (SMM; 38 intervention, 38 wait-list control) completed surveys at baseline, and 4- and 7-months post-baseline. Adherence was electronically monitored. Intention-to-treat, repeated-measures regressions showed improved adherence in the intervention vs. control group from baseline to follow-up [electronically monitored: b (95% CI) 9.24 (- 0.55, 19.03), p = 0.06; self-reported: b (95% CI) 4.50 (0.70, 8.30), p = .02]. Intervention participants showed marginally decreased negative religious coping beliefs in response to stigma [b (95% CI) = - 0.18 (- 0.37, 0.01), p = .06], and significantly lower medical mistrust [b (95% CI) = - 0.47 (- 0.84, - 0.09), p = .02]. Our intervention holds promise for improving HIV outcomes by empowering Latinx SMM to leverage innate resilience resources when faced with stigma.ClinicalTrials.gov ID (TRN): NCT03432819, 01/31/2018.
| S-EPMC8084890 | biostudies-literature
Project description:BackgroundPeople with HIV who inject drugs experience intersecting forms of stigma that adversely impact care access. This RCT aimed to evaluate effects of a behavioral intersectional stigma coping intervention on stigma and care utilization.MethodsWe recruited 100 participants with HIV and past-30-day injection drug use at a non-governmental harm reduction organization in St. Petersburg, Russia, and randomized them 1:2 to receive usual services only or an additional intervention of three weekly 2-h group sessions. Primary outcomes were change in HIV and substance use stigma scores at one month after randomization. Secondary outcomes were initiation of antiretroviral treatment (ART), substance use care utilization, and changes in frequency of past-30-days drug injection at six months. The trial was registered as NCT03695393 at clinicaltrials.gov.FindingsParticipant median age was 38.1 years, 49% were female. Comparing 67 intervention and 33 control group participants recruited October 2019-September 2020, the adjusted mean difference (AMD) in change in HIV and substance use stigma scores one month after baseline were 0.40, (95% CI: -0.14 to 0.93, p = 0.14) and -2.18 (95% CI: -4.87 to 0.52, p = 0.11), respectively. More intervention participants than control participants initiated ART (n = 13, 20% vs n = 1, 3%, proportion difference 0.17, 95% CI: 0.05-0.29, p = 0.01) and utilized substance use care (n = 15, 23% vs n = 2, 6%, proportion difference 0.17, 95% CI: 0.03-0.31, p = 0.02). The adjusted median difference in change in injecting drug use frequency 6 months after baseline was -3.33, 95% CI: -8.51 to 1.84, p = 0.21). Five not intervention-related serious adverse events (7.5%) occurred in the intervention group, one (3.0%) serious adverse event in the control group.InterpretationThis brief stigma-coping intervention did not change stigma manifestations or drug use behaviors in people with HIV and injection drug use. However, it seemed to reduce stigma's impact as an HIV and substance use care barrier.FundingR00DA041245, K99DA041245, P30AI042853.
| S-EPMC10173263 | biostudies-literature
Project description:This study used an intersectional approach to explore the association between enacted and internalized drug use and HIV stigma on HIV care outcomes among HIV-positive women who inject drugs in Ukraine. Surveys were conducted in Kyiv in 2019-2020. Among the 306 respondents, 55% were engaged in HIV care. More than half (52%) of participants not engaged in care reported internalized stigma related to both drug use and HIV status (i.e., intersectional stigma), compared to only 35% of those who were engaged in HIV care. Among those engaged in care, 36% reported intersectional enacted stigma compared to 44% of those not engaged in care; however, this difference was not statistically significant in the univariable analysis (p = 0.06). In the univariable analysis, participants who reported intersectional internalized stigma had 62% lower odds of being engaged in HIV care (OR 0.38, 95% CI 0.22, 0.65, p < 0.001). In the adjusted model, reported intersectional internalized stigma (aOR 0.52, 95% CI 0.30, 0.92, p = 0.026), reported intersectional enacted stigma (aOR 0.47, 95% CI 0.23, 0.95, p = 0.036), and knowing their HIV status for more than 5-years (aOR 2.29, 95% CI 1.35, 3.87, p = 0.002) were significant predictors of HIV care engagement. These findings indicate that interventions to improve HIV care engagement must address women's experiences of both HIV and drug use stigma and the different mechanisms through which stigma operates.
| S-EPMC9703403 | biostudies-literature
Project description:BACKGROUND:Tuberculosis (TB) affects, and claims the lives of, millions every year. Despite efforts to find and treat TB, about four million cases were missed globally in 2017. Barriers to accessing health care, inadequate health-seeking behavior of the community, poor socioeconomic conditions, and stigma are major determinants of this gap. Unfortunately, TB-related stigma remains unexplored in Ethiopia. METHODS:This mixed methods survey was conducted using multistage cluster sampling to identify 32 districts and 8 sub-cities, from which 40 health centers were randomly selected. Twenty-one TB patients and 21 family members were enrolled from each health center, and 11 household members from each community in the catchment population. RESULTS:A total of 3463 participants (844 TB patients, 836 from their families, and 1783 from the general population) were enrolled for the study. The mean age and standard deviation were 34.3 ± 12.9 years for both sexes (34.9 ± 13.2 for men and 33.8 ± 12.5 for women). Fifty percent of the study participants were women; 32.1% were illiterate; and 19.8% came from the lowest wealth quintile. The mean stigma score was 18.6 for the general population, 20.5 for families, and 21.3 for TB patients. The general population of Addis Ababa (AOR: 0.1 [95% CI: 0.06-0.17]), those educated above secondary school (AOR: 0.58 [95% CI: 0.39-0.87]), and those with a high score for knowledge about TB (AOR: 0.62 [95% CI: 0.49-0.78]) had low stigma scores. Families of TB patients who attended above secondary school (AOR: 0.37 [95% CI: 0.23-0.61]) had low stigma scores. TB patients educated above secondary school (AOR: 0.61 [95% CI: 0.38-0.97]) had lower stigma scores, while those in the first (AOR: 1.93: 95% CI 1.05-3.57) and third quintiles (AOR: 1.81: 95% CI: 1.08-3.05) had stigma scores twice as high as those in the highest quintile. Fear of job loss (32.5%), isolation (15.3%), and feeling avoided (9.3%) affected disclosure about TB. CONCLUSIONS:More than a third of Ethiopians have high scores for TB-related stigma, which were associated with educational status, poverty, and lack of awareness about TB. Stigma matters in TB prevention, care, and treatment and warrants stigma reduction interventions.
| S-EPMC7006204 | biostudies-literature
Project description:Gender inequitable beliefs, blaming attitudes, externalised and internalised stigma are commonly recognised barriers for intimate partner violence (IPV) survivors seeking help. However, the measurement of IPV stigma, its associations with inequitable gender beliefs and impacts on survivor disclosure, help-seeking behaviours, and mental health outcomes remain understudied. We explored women's agreement with statements about gendered power dynamics and violence in intimate heterosexual relationships, before identifying and psychometrically testing scales derived for measuring community norms and beliefs underlying stigma to IPV. We used data from a nationally representative sample of 596 women living in Botswana. Exploratory factor analysis (EFA) occurred with responses of IPV survivors, and involved items from the Community Ideas about Gender Relations, Community Ideas about Rape, and Gender Equitable Women Scales. For each EFA identified scale, we estimated reliability (McDonald's omega (ω)) and correlation with psychosocial outcomes related to IPV stigma. Among IPV survivors, we also considered whether survivors had disclosed their experience of abuse to others prior to the interview. Some 40.9% (n = 244) of women have experienced physical and/or sexual IPV at least once in their lives. Among them, an EFA of 31 gender beliefs and norms identified three latent variables: community norms about male dominance over female partners (C-MDP) (11 items; ω = 0.86); respondent beliefs about male dominance over female partners (I-MDP) (12 items; ω = 0.83); and survivor blaming attitudes (SBA) for the IPV they experienced (8-items; ω = 0.83). Some 15% of survivors had attempted suicide in the past, 8% had disclosed having suicidal thoughts, 49% were considered at risk for depression, and 18% at risk for post-traumatic stress disorder. Survivors who more strongly endorsed C-MDP appeared more likely to have attempted suicide (p = 0.04), and less likely to have disclosed their IPV experience prior to the study (p = 0.002). Survivors who more strongly endorsed SBA appeared more likely to have had suicidal thoughts (p = 0.02) and greater post-traumatic stress symptoms (p = 0.06). C-MDP, I-MDP and SBA appear related to psychosocial and disclosure outcomes. Gendered social norms may play an important role in understanding how survivors experience IPV stigma. We recommend further research into culture-informed practices that act to socialise such norms.
| S-EPMC11798532 | biostudies-literature
Project description:PurposeTo test the feasibility of introducing 'Free Time for Wellness' (FT4W) an intervention to increase healthy behaviours and reduce the risk of cancer.DesignFeasibility study; Setting: Washington Heights, New York, USA is a low socioeconomic status area.SubjectsMothers aged 18 and above with children under 12 years of age and living in Washington Heights were recruited.InterventionFT4W, a community-based intervention delivered through a neighbourhood-based app, offering weekly dance and yoga classes, food pantry visits and group playdates. Childcare professionals cared for participants' children during wellness activities.MeasuresA bespoke before and after survey was designed and tested for its ability to collect relevant data to assess the impact of FT4W. Outcomes included recruitment rates, participation, attrition, acceptability, and success of the community champion.AnalysisComparisons of proportions and means.ResultsTwenty-one mothers participated in the study of which 90% attended ≥ 1 FT4W activity; 65% ≥ 2; 52% ≥ 3. The survey was completed by a 100% of participants indicating it was easy to understand and not too burdensome. All measures detected change in constructs from baseline to follow-up. Availability of childcare was the most commonly (66%) reported reason participants were able to engage in the offered wellness activities.ConclusionConducting a larger-scale trial to assess the impact of FT4W is feasible considering 4 major lessons. (1) Recruitment, retention, and acceptability rates were high; however, moms need additional support to increase participation in wellness activities and improve tech literacy. (2) Research measures were sensitive enough to detect change, but the timing of assessments needs to be considered. (3) Participants greatly valued access to professional childcare. (4) The Community Champion is a necessary, but difficult role to fill that requires careful consideration by the Institutional Review Board (IRB).
| S-EPMC9060206 | biostudies-literature
Project description:BackgroundWomen living with HIV bear a disproportionate burden of stigma, especially in countries where gender discrimination is more common. A result is widespread domestic violence against women. This violence is itself stigmatized, but the intersectional stigma of HIV and domestic violence has not been well studied. Our work aimed to fill this research gap by exploring how domestic violence and HIV stigma intersect with other marginalized identities in women's lives.MethodsSemi-structured interviews were conducted in Kolkata, India with 31 women living with HIV and 16 key informants to gain an understanding of intersecting stigmas. Interviewees discussed women's experiences and perceptions of stigma and discrimination around HIV, domestic violence, and other marginalized identities. The coding of data was informed by an intersectional stigma framework. Thematic Network Analysis was used to group themes originating in the data into higher-order themes connecting to a global theme.ResultsThe findings presented are a qualitative self-report of violence. The three main themes developed were (1) the intersectional stigma of HIV and domestic violence amplified stigma as a whole, (2) the intersection of multiple stigmas worsens domestic violence, and (3) the stigma of HIV hides domestic violence. Specifically, HIV stigma triggered domestic violence and perpetrators reinforced HIV stigma through verbal abuse. Women with other marginalized identities, such as having daughters or being a widow, experienced substantial violence. Domestic violence stigma was worsened by HIV stigma as women hid the violence for fear of revealing their status. As a result, help-seeking from formal and informal sources decreased, which increased women's isolation.ConclusionsThe findings shape new understandings of how intersectional stigma of HIV, domestic violence, and marginalized social identities interact to amplify stigma and related violence. Women living with HIV who have multiple marginalized identities should be prioritized for violence reduction interventions.
| S-EPMC11724566 | biostudies-literature