Feasibility of a Stigma Reduction Intervention for Human Immunodeficiency Virus (HIV)-Infected Women

Nearly 30 years into the Acquired Immune Deficiency Syndrome (AIDS) epidemic, stigma is
still hampering efforts to stop its spread. Human Immunodeficiency Virus(HIV)-infected women
are particularly vulnerable to both perceived and enacted stigma, which together are
referred to as internalized stigma. As the demographic face of HIV infection in the US has
changed from being largely a disease of gay white men to one of poor minority women, the
debilitating effects of stigma have worsened. It has a profound impact on prevention and
treatment efforts; women with HIV infection may be fearful of insisting that their sexual
partners wear condoms because of the possibility that this may signal their serostatus, and
they may not want to take antiretroviral medications in front of others, fearing that people
may ask questions about their pills and the reasons for taking them. The effects of stigma
include a cascade of other negative outcomes as well, including poor self-esteem and
self-efficacy, especially self-efficacy for disclosure and for coping. Yet it is nearly
impossible to intervene with those who stigmatize others because this group is often as
broad as the general public, and they may not be interested in an intervention. Therefore,
the best approach may be to work with women who are experiencing stigma, in an effort to
decrease stigma, improve self-esteem and coping self-efficacy, and facilitate safe
disclosure. To date, there have been few interventions to help HIV-infected women deal with
stigma. One option would be a video converted to an Moving Picture 4 (MP4) file that can be
viewed on an iPod Touch, a small portable viewing device, allowing the woman privacy and
safety in viewing. Barroso (primary investigator on the proposed study) assisted in the
creation of a video on stigma for women with HIV infection, based on the results of a
qualitative metasynthesis. The 45-minute video presents vignettes about five seropositive
women and the ways in which stigma has impacted their lives. The primary aim of the proposed
study is to assess the feasibility, acceptability and utility of implementing this low-cost,
technologically delivered intervention to mitigate the negative effects of HIV-related
stigma on seropositive women. The secondary aim is to compare outcomes across time in women
who receive the stigma intervention with those of a control group receiving usual care at
baseline, 30, and 90 days, and to determine effect sizes for a larger definitive study to
test the efficacy of this intervention in reducing internalized stigma, improving coping
self-efficacy and self-esteem, and facilitating safe disclosure in HIV-infected women. The
investigators believe that this intervention is innovative because they are the first
investigators to propose using a video, developed from the findings of a metasynthesis of
studies about stigma as it is experienced by HIV-infected women, for this purpose. It is
also innovative in the use of a portable viewing device which will allow the women to safely
and privately view the video. The investigators further believe that this intervention has
the potential to make a significant impact, at a low cost in terms of money and personnel
time, in mitigating stigma.

Inclusion Criteria:

- speaks, understands, and reads English

- Scores over 50 on Internalized Human Immunodeficiency Virus (HIV) Stigma Scale

- HIV positive

- mentally competent to give informed consent