Adaptation and Implementation of an Intervention to Reduce HIV-Related Stigma Among Healthcare Workers in the United States: Piloting of the FRESH Workshop

Abstract

HIV-related stigma has been shown to have profound effects on people living with HIV (PLWH). When stigma is experienced in a healthcare setting, negative health outcomes are exacerbated. We sought to assess the feasibility and acceptability of a healthcare setting stigma-reduction intervention, the Finding Respect and Ending Stigma around HIV (FRESH) Workshop, in the United States. This intervention, adapted from a similar strategy implemented in Africa, brought together healthcare workers (HW) and PLWH to address HIV-related stigma. Two pilot workshops were conducted in Alabama and included 17 HW and 19 PLWH. Participants completed questionnaire measures pre- and post-workshop, including open-ended feedback items. Analytical methods included assessment of measures reliability, pre-post-test comparisons using paired t-tests, and qualitative content analysis. Overall satisfaction with the workshop experience was high, with 87% PLWH and 89% HW rating the workshop "excellent" and the majority agreeing that others like themselves would be interested in participating. Content analysis of open-ended items revealed that participants considered the workshop informative, interactive, well-organized, understandable, fun, and inclusive, while addressing real and prevalent issues. Most pre- and post-test measures had good-excellent internal consistency reliability (Cronbach's alphas ranging from 0.70 to 0.96) and, although sample sizes were small, positive trends were observed, reaching statistical significance for increased awareness of stigma in the health facility among HW (p = 0.047) and decreased uncertainty about HIV treatment among PLWH (p = 0.017). The FRESH intervention appears to be feasible and highly acceptable to HW and PLWH participants and shows great promise as a healthcare setting stigma-reduction intervention for US contexts.

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

“…This includes a recognition of the importance of addressing stigma in health facilities [72], yet concerted efforts to tackle stigma at any scale within countries are lacking, apart from Thailand [73]. One reason for such inaction may be the small, but growing, body of evidence of effective intervention models for HIV‐stigma reduction, particularly in health facilities [46,49‐56]. This paper adds to that literature.…”

“…Yet despite this evidence and global recognition of the need to tackle stigma – especially in health facilities – there is little concrete evidence of concerted efforts by countries and donors to scale‐up stigma‐reduction interventions in health facilities within national HIV responses. This may be in part due to the still nascent body of evaluated intervention approaches to stigma‐reduction in health facilities [46,49‐56].…”

Association between Perceived Discrimination in Healthcare Settings and HIV Medication Adherence: Mediating Psychosocial Mechanisms

“…A recent assessment of health care setting stigma among providers in Alabama 2 informed the adaptation and implementation of an intervention in which health care professionals and PLWH learned about HIV-related stigma and were equipped with the skills to address HIV-related stigma in the community and in the health care setting, which has shown promise in pilot assessments. 55 …”

Addressing Disease-Related Stigma During Infectious Disease Outbreaks

“…32 Studies indicate that messaging and education aimed at stigma among public health and health-care workers can have an impact on their attitudes. [33][34][35]…”