Group-based interventions address HIV stigma

Group-based interventions have the potential to address HIV-related stigma among adolescents living with the virus, finds a recent study from researchers at the Brown School at Washington University in St. Louis and Makerere University in Uganda.

HIV stigma is a major barrier to all aspects of the HIV care continuum. However, few HIV stigma reduction interventions exist, especially those targeting adolescents. To address these gaps, a research group led by Proscovia Nabunya, an assistant professor at the Brown School, pilot tested the Suubi4Stigma cluster randomized clinical trial, to address stigma and improve treatment adherence among adolescents with HIV in Uganda.

The study recruited 89 adolescent-caregiver pairs from nine HIV health clinics. Participants were randomly assigned to one of three study arms: receive usual care, group-cognitive behavioral therapy (G-CBT), or a family strengthening intervention delivered via multiple family group (MFG-FS). These interventions spanned three months, with data collected at baseline, three and six-months post intervention initiation.

Study findings published in the AIDS and Behavior journal indicate that the study was highly feasible and acceptable by both adolescents and their caregivers, with a retention rate of 94%. Across study arms, session attendance and fidelity of the interventions was high, exceeding 85%, and participants rated highly their satisfaction with the interventions.

In addition, the study examined the preliminary impact of the interventions on HIV stigma, adolescents' mental health and treatment adherence. Findings published in the Journal of Pediatrics indicate that compared to the usual care arm, participants in the MFG-FS arm reported lower levels of internalized stigma and depressive symptoms. On the other hand, participants in the G-CBT arm reported lower levels of anticipated stigma and improved self-concept over time. Both interventions enhanced treatment adherence.

"These preliminary findings underscore the importance of bringing adolescents and families together in a group setting to help facilitate peer support, shared experiences and enhance interpersonal and coping skills," Nabunya said. "With this compelling evidence, the next step will be to test the efficacy of these interventions in a larger trial."