A mixed method study of a community-based HIV stigma reduction “hub” network
Prinsloo, Catharina Dorothea
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Over the years, growing concerns were raised about the serious effect that HIV stigma has on the global HIV and AIDS-prevention response, with appeals to regard HIV stigma reduction as one of the most important factors that need to be addressed in any HIV-prevention strategy. Studies have found scant evidence of comprehensive community-based approaches to reduce stigma, as few of the existing strategies address the community, but maintain the focus mainly on behaviour change in the individual. This research study is a follow-up study to two other studies. The first study focused on people living with HIV (PLWH) and nurses in health care settings; and the second was a trans-disciplinary, comprehensive, community-based HIV stigma reduction and wellness-enhancement intervention that involved PLWH and people living close to them (PLC). This HIV stigma-reduction community “hub” network intervention was specifically planned as an intervention for the community, targeting PLWH and their community members who live in the same ward in the Tlokwe municipality in the North West Province of South Africa. The objectives of the study were to explore, describe and determine whether an HIV stigma-reduction community “hub” network intervention in a South African urban area will make a difference in the HIV stigma experiences of PLWH, as well as related stigmatisation by their community; to describe the implementation of this intervention; and to determine the change in depression and psychosocial well-being of PLWH and their community before and after the intervention. The HIV stigma-reduction community “hub” network intervention defines a “hub” as a two-person mobiliser team consisting of a PLWH and a non-infected PLC who are inhabitants of the same community and functions from a “hub” in the community. The strategy is based upon the involvement of PLWH and PLC, as community mobilisers, who share their knowledge and who mobilise and empower their own community to reduce HIV stigma. A convergent parallel mixed-method design with a single case pre-test post-test design for the quantitative data, and an interpretive description approach for the qualitative data were utilised. The sample for this study included PLWH recruited through accessibility sampling as well as community members living in the same municipal ward through random voluntary sampling. Valid measures were used to determine and describe whether the HIV stigma-reduction community “hub” network intervention will affect change in the HIV stigma experiences of PLWH, the perceived stigmatisation by their community, as well as the depression and psychosocial well-being of both PLWH and the community. A sub-sample of both groups was selected by means of purposive voluntary sampling for the qualitative part of the study, consisting of in-depth interviews about stigma experiences of PLWH, as well as stigmatisation of the community toward PLWH. For the description of the HIV stigma-reduction community “hub” network intervention, a holistic single-case study design was used. Participants were recruited according to accessibility, during the various community activities, with no differentiation between PLWH and people of unknown HIV status residing in that community. Findings indicate that the HIV stigma-reduction community “hub” network intervention, as planned and implemented, was successful in initiating the onset of changes in a community through the PLWH and PLC, as community mobilisers were active in the community “hub” network to mobilise their own communities towards HIV stigma reduction, sharing their knowledge and mobilising and empowering their own community. Changes were observed on an individual and social level. Recommendations focus on using and strengthening the present community intervention, adjusting some of the scales used in this study and ensuring stronger collaboration between health and social disciplines to address the various manifestations and to change the contexts of HIV stigma. It is furthermore recommended that future HIV stigma-reduction interventions give special attention to addressing aspects of psychosocial well-being.
- Humanities