For HIV-infected children and adolescents in resource-limited settings, HIV/AIDS- related stigma (H/A stigma) shapes every aspect of their HIV management, from medication adherence to decisions about HIV disclosure. Youth report that H/A stigma in schools, manifest through teacher attitudes and actions as well as limitations in the curriculum, shapes the beliefs of their peers and their own feelings about HIV, and often hurts their HIV management. We do not know the most effective strategies to reduce the H/A stigma these youth experience. The long-term goal of our research team is to provide evidence to improve chronic disease management among HIV-infected children and adolescents in resource-limited settings. The purpose of this proposal is to evaluate whether an innovative, film-based, multimedia teacher training curriculum intervention would decrease Kenyan teachers' negative attitudes and beliefs about HIV and reduce the H/A stigma in their teaching and classrooms. This work will take place through a long-standing academic partnership between Kenyan and North American universities called the Academic Model Providing Access to Healthcare (AMPATH), where we also maintain long-standing community partnerships.
The specific aims for this study are to:
Aim 1 : Assemble a multimedia teacher training curriculum package, focused on HIV and H/A stigma and adapted for maximum cultural relevance, curricular cohesion, and impact among Kenyan primary and secondary school teachers.
Aim 2 : Assess the impact of the Teach HADITHI intervention on Kenyan teachers' attitudes, beliefs, and knowledge about HIV and the level of HIV-related stigma among teachers. Exploratory Aim 3: Examine whether HIV-infected children and adolescents in classrooms with teachers who have received the Teach HADITHI intervention report less perceived, enacted, or internalized stigma compared to those in classrooms with teachers who have not. To develop and modify the teacher training package, we will utilize qualitative approaches, including focus groups and cognitive interviews with subject matter experts. To assess efficacy, we will conduct a cluster randomized control trial, randomizing by school. All teachers within the intervention schools will go through a teacher training intervention that includes viewing locally created films capturing the stigma experiences of HIV-infected Kenyan children and structured interactions with an HIV-infected adolescent content expert and a health care professional. The control schools will have no training intervention. We will evaluate all teachers, both intervention and control, on their knowledge, attitudes and beliefs related to persons living with HIV using a standardized questionnaire given 6 months apart. We will also conduct an exploratory evaluation of HIV-infected youth enrolled in both AMPATH and in the participating schools, measuring the H/A stigma they have perceived, experienced, or internalized during the six months following the intervention. This research will significantly impact our understanding of community strategies to reduce H/A stigma impacting HIV-infected children and adolescents.

Public Health Relevance

This novel, exploratory study will generate new information on strategies to reduce the HIV-related stigma experienced by children and adolescents living with HIV in western Kenya. The proposed research aims to reduce the HIV-related stigma that children and adolescents experience and learn from within their primary and secondary school classrooms by implementing an innovative teacher training program that uses films and facilitated discussions to increase teachers' empathy for people living with HIV and increase knowledge about HIV. The current evidence on effective and feasible interventions to decrease HIV-related stigma in communities is scant, and this project will help address this critical gap in the knowledge base.

National Institute of Health (NIH)
Fogarty International Center (FIC)
Exploratory/Developmental Grants (R21)
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Special Emphasis Panel (ZRG1)
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Bansal, Geetha Parthasarathy
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Indiana University-Purdue University at Indianapolis
Schools of Medicine
United States
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