Considerable research has been conducted on HIV stigma, documenting its high prevalence worldwide. HIV stigma has been tied to adverse effects on HIV prevention, treatment engagement, adherence to antiretroviral therapy (ART). HIV stigma and its accompanying fear of discrimination also adversely affect viral load, depression, suicidality, self-esteem, quality of life, and HIV-transmission risk. Despite the progress in documenting the prevalence and negative consequences of HIV stigma, little is known about the best way to reduce stigma?s deleterious impact. Accordingly, the broad objective of this research is to identify interventions to reduce HIV stigma and its impact on HIV prevention, treatment, and care and health among adolescents living with HIV (ALWH) in Botswana, a sub-Saharan African nation with the third highest HIV prevalence in the world. Another important goal is to improve the capacity of researchers in Botswana to develop interventions to improve HIV prevention, treatment, and care. This project is a collaborative effort of a multidisciplinary team of researchers from the United States and the Republic of Botswana who have a history of collaborating and draws on a more than decade-long University of Botswana-University of Pennsylvania partnership. Members of the team have developed several efficacious HIV risk-reduction interventions for a variety of populations of adolescents. Specifically, the team will conduct preliminary exploratory research to develop a theory-based, developmentally and culturally appropriate HIV stigma-reduction intervention to improve ART adherence and reduce HIV stigma?s adverse impact on adolescents? health. The intervention will be an adaptation of Teen Club, an intervention implemented with Batswana ALWH ages 13 to 17 years since 2005 that does not address HIV stigma. The bane of intervention research is that resulting efficacious interventions too often are not disseminated because they are not sustainable in the settings that need them. We seek to circumvent this problem by adapting an intervention employed for over 10 years in the proposed setting, resulting in an intervention with a high probability of sustainability. We will conduct focus groups with ALWH, peer educators who implement the existing program, and parents and other caregivers of ALWH, conduct a survey with ALWH to examine correlates of stigma, consult with a Community Advisory Board, and integrate what we learn with Social Cognitive Theory to adapt the intervention to address HIV stigma while ensuring that it is theory-based and developmentally and culturally appropriate. We will conduct a pilot feasibility randomized controlled trial (RCT) to determine the adapted intervention?s feasibility and acceptability. The proposed work includes a Science of Behavior Change Fellows Program with a series of workshops implemented in concert with the project?s activities to improve the capacity of researchers in Botswana to develop interventions to improve HIV prevention, treatment, and care. Based on the preliminary research, we will develop a grant application to test the stigma-reduction intervention?s efficacy in a full-scale RCT with ALWH.
HIV stigma is having adverse effects on HIV prevention, treatment engagement, adherence to antiretroviral therapy (ART) as well as health outcomes, viral load, depression, suicidality, quality of life, in adolescents living with HIV. The proposed research will address a significant gap in scientific knowledge: the lack of efficacious strategies to reduce HIV stigma and its negative consequences on adolescents. This research will culminate in an intervention whose efficacy can be evaluated in a subsequent randomized controlled trial.
