Stigma, psychological functioning and efficacy of stigma reduction intervention among people living with HIV and AIDS in Limpopo Province

Abstract

There is still a high prevalence rate of stigmatisation of people living with HIV and AIDS (PLWHA) in South African communities. HIV and AIDS stigma has been demonstrated to have adverse effects on the psychological functioning of people living with HIV and AIDS. The main aims of this study was twofold: 1) to determine HIV and AIDS stigma experiences and psychological functioning among PLWHA in Limpopo Province, South Africa, and 2) to design, implement, and to empirically evaluate the efficacy of an HIV and AIDS stigma reduction intervention. Adopting a two phase study approach, the study was anchored on a cross-sectional design for phase I, and a pre-test post-test two group design for phase II. Phase I study was a baseline assessment of HIV and AIDS stigma experiences as well as determination of psychological functioning among PLWHA with a cohort of people living with hypertension (PLWHPT), while phase II focused on empirically tailoring an HIV and AIDS stigma reduction intervention, the Stigma Coping Skills Intervention (SCSI). To determine HIV and AIDS stigma, the HIV and AIDS stigma scale was used, while the GHQ 28 was used to determine psychological functioning. A total of 600 participants were utilised for phase I study, 300 were assigned to the experimental group (PLWHA) and 300 to the control group (PLWHPT). Purposive sampling method was employed for phase I study. For phase II study, a total of 24 participants were employed, assigned to two groups (12 participants experimental and 12 control). Simple random sampling method was used for the phase II study. Findings indicated that PLWHA experienced significantly higher levels of enacted stigma (t=-11.79, P< .001) over other stigma dimensions, and poorer psychological functioning than PLWHPT (t= -3.43, P< .001). Relatively, PLWHA experienced significantly less internalised (t=37.56, P< .001) and perceived stigma than PLWHPT (t=41.71, P< .001). Enacted HIV and AIDS stigma had a significant direct positive relationship with psychological dysfunctions (β = .198, p<.01), and was found to significantly predict psychological dysfunctions. Enacted HIV and AIDS had a significant direct negative relationship with age (β = -126, p<.05), and non-significant direct negative relationship with duration of diagnosis. Age was found to have significant direct negative relationship with psychological dysfunctions (β = -.140, p<.05). Duration of diagnosis had a non-significant direct negative relationship with psychological dysfunctions. The SCSI demonstrated efficacy in HIV and AIDS stigma reduction, as well as improving psychological functioning. HIV and AIDS stigma is still pervasive and continues to negatively impact the psychological functioning of PLWHA. The SCSI is effective in reducing HIV and AIDS stigma and psychological dysfunctions among PLWHA. It would be beneficial to integrate psychological interventions into the routine treatment programmes for PLWHA, for prevention of the development of psychological dysfunctions, and treatment, which will help break the psychological dysfunctions-induced vicious cycle of HIV transmission.