A Randomized Controlled Trial of the Efficacy of a Stigma Reduction Intervention for HIV-Infected Women in the Deep South

Abstract

The aim of this study was to compare outcomes (self-esteem, coping self-efficacy, and internalized stigma) across time in HIV-infected women living in the Deep South who received a stigma reduction intervention (n=51) with those of a control group (n=49) who received the usual care at baseline, and at 30 and 90 days. We recruited 99 women from clinics and an AIDS service organization; they were randomized by recruitment site. A video developed from the results of a qualitative metasynthesis study of women with HIV infection was loaded onto iPod Touch devices. Participants were asked to watch the video weekly for 4 weeks, and to record the number of times they viewed it over a 12-week period. We examined the trajectory model results for efficacy outcomes for the intent-to-treat and the supplemental completers groups. There was a treatment-by-time effect for improved self-esteem (intent-to-treat: p=0.0308; completers: p=0.0284) and decreases in internalized stigma (intent-to-treat: p=0.0036; completers: p=0.0060), and a treatment-by-time-by-time effect for improved coping self-efficacy (intent-to-treat: p=0.0414; completers: p=0.0321). A medium effect of the intervention in terms of improving self-esteem was observed when compared with the control condition in those who completed the study. The magnitude of the intervention effect, however, was large with regard to reducing overall stigma, improving social relationships, and decreasing stereotypes in both groups.

Prevalence of Internalized HIV-Related Stigma Among HIV-Infected Adults in Care, United States, 2011–2013

“…Previous interventions have had success in reducing internalized stigma. An intervention using videos and other technology that normalize HIV and empower HIV-infected women in the southern United States was effective in reducing internalized stigma and enhancing self-esteem and coping mechanisms [38]. Our findings suggest that other groups that have high risk of stigma, such as trans-gender or Hispanic/Latino individuals, may benefit from a similar tailored intervention.…”

Population Density and AIDS-Related Stigma in Large-Urban, Small-Urban, and Rural Communities of the Southeastern USA

“…One intervention approach that demonstrated promise in addressing stigma was tested in the southern United States. Barroso et al (2014) tested the effects of a video that depicted women living with HIV and managing the stigma they had experienced. The video was delivered over a mobile device and demonstrated reductions in internalized stigma compared to a control condition that did not receive a stigma reduction intervention.…”

Feasibility of Using an iPod Touch Device and Acceptability of a Stigma Reduction Intervention with HIV-Infected Women in the Deep South

“…Women in both the intervention and control arms of the study were from diverse racial and ethnic backgrounds. The intervention and control arms did not differ significantly with regard to age, racial/ethnic group, years of education, current employment, number of people residing in the household, and serving as a primary caregiver for someone else in the household or monthly income (28). …”

“…Efficacy data were collected on HIV-related stigma, self-esteem, and coping self-efficacy at baseline, 30 and 90 days in both the control and intervention groups to evaluate whether the intervention improved these psychosocial outcomes when compared to the control condition. For information about the efficacy of the stigma reduction intervention, please see Barroso et al (28). …”