HIV prevention intervention to reduce HIV-related stigma: evidence from China.

HIV prevention intervention to reduce HIV-related stigma: evidence from China.

The National Institute of Mental Health Collaborative HIV/Sexually Transmitted Disease Prevention Trial provided a unique opportunity to test whether, with the community-based diffusion of HIV/sexually transmitted disease prevention information and an elevated understanding of HIV, the level of stigmatizing attitudes toward people living with HIV in the community would be reduced. A total of 4510 market workers in Fuzhou, China, participated in the study, and longitudinal analyses included study samples of 3785 participants in the 12-month follow-up and 3716 participants in the 24-month follow-up. The authors graphically examined the change in HIV-related stigma indicators over time between control and intervention groups using boxplot and kernel density estimation. A logistic regression analysis with proportional odds model was further used to examine the intervention effect on HIV-related stigmatizing attitudes. Compared with no change over time for the control group, the intervention successfully reduced the level of HIV-related stigmatizing attitudes among the target population at the 12-month follow-up, and the effect increased by two-fold (with respect to odds ratios) at the 24-month follow-up. The intervention demonstrated positive attitude changes associated with HIV-related stigma. These results show the importance of social norms, rather than simply individual behaviours, in developing and implementing stigma reduction campaigns.

This trial was designed to identify, recruit, train, and engage community popular opinion leaders to convey HIV-risk reduction messages to food vendors in the markets that were randomised to the intervention arm. The ‘unintended’ finding of stigma reduction in a trial designed to reduce HIV/STD incidence and risk behaviour is puzzling. It may be due to community mobilisation and the use of social networks to convey information. It does suggest that HIV prevention and stigma reduction initiatives should be integrated for maximum benefit.