Change–over–time : a comprehensive community–based HIV stigma reduction and wellness enhancement intervention
Chidrawi, Helena Christa
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This study forms part of a larger SANPAD project focusing on a comprehensive community-based HIV stigma reduction and wellness enhancement intervention, responding to the continuous burden of HIV stigma on both national and international levels and the paucity of research in sustainable HIV stigma reduction interventions. HIV stigma is considered all over the world as a complex, far-reaching and powerful phenomenon that continues to affect people living with HIV (PLWH) and also people living close to them (PLC). The impact of stigma has far reaching effects on aspects like the wellness of PLWH and PLC, but also on the health behaviour of PLWH. There is paucity in research on the lasting effect of HIV stigma reduction interventions, intervention within a community context, as well as in urban and rural settings. The research objectives of this study were to test the change-over-time in HIV stigma experiences of PLWH and stigmatization by PLC with regard to the psychosocial well-being of PLWH and PLC, and with regard to health behaviour of PLWH in both urban and rural settings, following a comprehensive community-based HIV stigma reduction intervention. A quantitative experimental single system research design with a pre-test and repetitive post-tests were conducted by means of purposive voluntary sampling for PLWH and snowball sampling for PLC. The intervention was based on three tenets, namely a) the sharing of information on HIV stigma and coping with it, b) the equalisation of relationships between PLWH and PLC through increased interaction and contact, and c) empowerment of both PLWH and PLC towards leadership in HIV stigma reduction through practical knowledge and experiences of planning and implementing HIV stigma reduction projects in their own communities. Several valid and reliable scales and instruments were used to measure effect. The initial analysis indicated no statistically significant difference between stigma experiences of PLWH and stigmatisation by PLC from urban and rural settings, or between psychosocial well-being of PLWH and PLC or health behaviour of PLWH from the two different settings. The urban-rural data was therefore pooled for the further analysis. The similarity of data could possibly be ascribed to the fact that most of the participants were Setswana-speaking and living in the North West Province. Stigma experiences as well as stigmatisation could be decreased and the decrease could be sustained over a year through the comprehensive community-based HIV stigma reduction intervention. The findings also showed that changes-over-time in psychosocial well-being following the intervention were better sustained by the PLC than the PLWH. Results furthermore indicated that HIV stigma reduction positively influenced the health behaviour of the PLWH. Recommendations for further HIV stigma reduction and wellness enhancement include the continued application of this comprehensive community-based HIV stigma reduction and wellness enhancement intervention, with its supporting tenets, content and methodology. This intervention should, however, be expanded into urban and rural communities, and to different cultures as well. It would be meaningful to build HIV stigma reduction community-based networks. More effort could be made to specifically include a workshop for PLWH on psychosocial well-being as well. HIV stigma interventions should be an indisputable part of health behaviour change workshops for PLWH.
- Health Sciences