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Feasibility, Acceptability, and Initial Efficacy of the ‘Unity Workshop’: An Internalized Stigma Reduction Intervention for African-American Women Living with HIV. D. Rao, M. Desmond, M. P. Andrasik, T. Rasberry, N. Lambert, S. E. Cohn, J. M. Simoni. Conceptual Model. Culture - PowerPoint PPT Presentation
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Feasibility, Acceptability, and Initial Efficacy of the ‘Unity Workshop’:
An Internalized Stigma Reduction Intervention for African-American Women Living with HIV
D. Rao, M. Desmond, M. P. Andrasik, T. Rasberry, N. Lambert, S. E. Cohn, J. M. Simoni
Conceptual Model
Public Level
Individual Level
Race
Gender
HealthCondition(s)
InternalizedStigma
PoorTreatmentUtilization
PoorHealth
Outcomes
Culture(Social norms, shared beliefs about body, health & illness, power structures)
PublicStigma
InstitutionalizedStigma
1Rao et al., 2007 2Rao et al., 2011
Race
Gender
(OtherStatuses)
PoorTreatmentUtilization
Culture(Social norms, power structures, shared beliefs about body, health & illness,)
PublicStigma
InstitutionalizedStigma
Reducing HIV/AIDS Stigma• Societal level1
– Removal of institutional stigmas– Microfinance programs (economic empowerment)– Community organizing
• Individual level2,3
– Education/Information– Coping Skills Acquisition– Contact with Affected Persons (e.g. Social Support)
1Link & Phelan, 2001; 2 Brown, Trujillo, Macintyre, 2001; 3Corrigan, 2011
• HIV Stigma Toolkit developed by International Center for Research on Women (ICRW)1 – Developed in Zambia, facilitators trained globally– We chose from 40+ exercises based on focus groups
feedback
• We developed ‘trigger videos’ from Toolkit scenarios/focus group content in order to – model proactive behaviors – trigger discussion
ICRW HIV Stigma Toolkit
1Kidd, Clay, Chiiya, 2007
The Unity Workshop
• Piloted as 8-hour workshop across 2 afternoons
• Peer facilitated• Group setting• Participants
– 24 African American women living with HIV– Living with HIV from 3 months to 25 years
Content Examples
• “Group Expectations” (e.g. Mutual Respect, No right or wrong answers)
• Personal Experiences of Stigma• Coping with Stigma (sharing methods)• Role play – navigating stigmatizing situations
Web of String represented “Peace,” “Unity,” “Togetherness”
Methods• Pre-test post-test design• Paired t-tests• Primary outcome: Stigma Scale for Chronic
Illness (SSCI), 14 item scale adapted for African-Americans living with HIV1
1Rao, Choi, et al., 2009; Rao, Molina, et al., under review
Results
Baseline Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 80tan29a566029
0tan30a566030
0tan1a56601
0tan2a56602
0tan3a56603
0tan4a56604
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0tan8a566080tan7a56607
33
34
Average Stigma Scores (24 attendees)
Day 1 to 2: t=2.05 (df=20), p=0.054Day 1 to Day 8: t=1.95 (df=18), p=0.067
Limitations/Future Directions• No control group• Trends/non-significance likely related to small
sample size• Booster session potentially helpful• Next step: randomized clinical trial
Thank You!• Our Participants• Tom Furtwangler (Video Producer), James and
Margaret Longley (Camera and Sound), Yamile Molina (Scripting)
• NIH K23 MH 084551
Questions? [email protected]