Community-Based Interventions that are Effective against HIV-Related Stigma. A Systematic Review of Evidence in Sub-Saharan Africa.

Abstract

Background HIV-related stigma remains a key barrier to the attainment of the UNAIDS global goal of ending AIDS by 2030. Due to the social and contextual nature of HIV-related stigma, community-based interventions may be more effective. In this review we synthesized evidence on features of community-based interventions that have been reported to be effective against HIV-related stigma in Sub-Saharan Africa. Methods We searched MEDLINE, EMBASE, CINAHL, Psych INFO, and Web of science in July 2023. We also searched Google Scholar and reference lists of all selected studies. Included studies were randomized controlled trials, mixed methods studies, as well as pre-test and post-test studies that evaluated the effectiveness of a community-based intervention to reduce HIV-related stigma in the general population or among specific groups. Data extraction was done using a pre-designed and pre-tested form. Framework thematic analysis was used to qualitatively synthesize intervention characteristics of included studies. Results A total of nine journal articles were included, largely with some concerns regarding methodological quality. Most studies involved People Living with HIV (PLH) alone as intervention recipients and as intervention implementers. Community members with unknown HIV status were involved in only 2 studies. The intervention strategies were largely information sharing through workshops and training as well as individualized counselling. In few studies, additional support in form of referrals, nutritional supplements, and adherence support was provided to PLH during the interventions. Most studies were judged to be of moderate to high cost except in 3 where the intervention implementers were PLH within the community, volunteering in the home-based support approach. The involvement of community members in the design of intervention strategies was not seen in all the studies. Conclusion Community-based interventions against HIV-related stigma have been multifariously developed in sub-Saharan Africa. However, comprehensive strategies involving the stigmatized and the ‘stigmatizers’ in a social change approach are lacking. The application of strategies without involvement of community members in their design takes away a sense of community responsibility and this threatens sustainability of such interventions. The HIV-competent framework can act as a benchmark for future design of realistic community-based interventions against HIV-related stigma.