Evaluating interventions that reduce HIV stigmaA

Evaluating interventions that reduce HIV stigma may help to craft effective stigma-reduction programs. This study evaluates the effects of a community popular opinion leader HIV/STI (sexually transmitted infection) intervention on stigma in urban, coastal Peru. Mixed effects modelling was used to analyze data on 3,049 participants from the Peru site of the NIHM collaborative trial. Analyses looked at differences between the comparison and intervention groups on a stigma index from baseline to 12- and 24-month follow-up. Sub-analyses were conducted on heterosexual-identified men (esquineros), homosexual-identified men (homosexuales), and socially marginalized women (movidas). Compared to participants in the comparison group, intervention participants reported lower levels of stigma at 12- and 24-month follow-up. Similar results were found within esquineros and homosexuales. No significant differences were found within movidas. Findings suggest that interventions designed to normalize HIV prevention behaviours and HIV communication can reduce HIV-related stigma and change community norms.

For abstract access click here:

Editors’ note: Community popular opinion leaders are people who live among their peers and are well respected by others. This large NIMH trial (National Institute of Mental Health Collaborative HIV/STD Prevention Trial), based on the theory of diffusion of innovation, recruited popular, well-respected individuals in 3 coastal cities of Peru to talk about HIV prevention during casual conversations with their peers. The primary outcomes of interest were HIV testing uptake and decreased sexual risk. Interestingly, though the intervention was designed to normalize HIV prevention behaviours, it had measurable effects on stigma. Qualitative studies are underway now to determine how peer-led casual conversations could have had the effect on stigma that they did for men but not for women. Clearly social norms, perceptions, and stigma are all interlinked and vary by culture and geography. More research on effective stigma reduction strategies is needed in different contexts around the world to increase HIV testing uptake, stimulate adoption and maintenance of safer sex behaviours, and encourage acceptance of people living with HIV and at risk of HIV acquisition.