Success! Interventions that work to reduce HIV stigma & discrimination in communities: Results of an evaluation study in Thailand

Aparna Jain, MPH1

Ratana Nuankaew2

Pakprim Oranop na Ayuthaya3

Kerry Richter, PhD4

Anne Stangl, PhD5

XIX International AIDS ConferenceJuly 25, 2012

1Johns Hopkins University; 2Population & Community Development Association (PDA); 3Pact Thailand; 4 Institute for Population and Social Research, Mahidol University; 5International Center for Research on Women

2

Outline

• Project Interventions• Study Design• Results• Conclusion

3

Project Intervention

4

Positive Partnership Project Phase II

Goal1. Increase quality of life of people living with

HIV/AIDS 2. Increase income levels of people living with HIV3. Reduce HIV stigma and discrimination in the

community

Two models4. PPP clubs (PPPC)5. Village development banks (VDB)

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Community Level Stigma Activities

1. Monthly meetings on banking day2. HIV campaigns 3. IEC materials with key messages

– Posters– Banking slips– Radio dramas

4. Funfairs – HIV/AIDS activity days

Banking slips with HIV key messageFunfair

Poster

Banking Day at VDB

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Project Sites & Duration

• 11 PPP Clubs– Urban sites: Bangkok, Chiang

Mai, and Chonburi– Rural sites: Chiang Rai,

Nakonrachasima, Khon Kaen

• 12 Village Development Banks– Rural sites: Chiang Rai,

Nakonrajasima, Khon Kaen

• April 2008–September 2010

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Study Design

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Community Dataset• Panel of 11 communities (6 PPPC & 5 VDBs)• Two cross-sectional surveys:

– Baseline survey (October 2008 – March 2009)– Endline survey (November 2010 – January 2011)

• Sampling frames of households• Systematic random sampling of households • All individuals 15 years or older interviewed in

each household

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Stigma Measures Previously validated stigma measures :1. Fear-driven stigma

– Fear of HIV transmission2. Value-driven stigma

– Shame associated with having HIV

Scale development:• Principle component factor analysis at baseline, confirmed

at endline• Predicted regression scores• Standardized scale to have a mean of 50 and standard

deviation of 10, scores range from 0 to 100

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Results

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Respondent Characteristics• Respondent characteristics were similar at baseline & endline

15-29 30-39 40-49 50+0

5

10

15

20

25

30

35

40

BaselineEndline

Age

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Correct HIV Knowledge Improved

Reducing sexual interactions can prevent HIV

Having sex with those who look clean cannot prevent HIV

Being infected with HIV is not different from being sick with AIDS

There are medicines that can inhibit HIV (ARTs)

Exposure to HIV positive indivdiual's skin canot transmit HIV

Exposure to sweat/saliva of HIV postive individual cannot transmit HIV

Sharing personal items (nail cutter) cannot transmit HIV

Not all babies get HIV from an HIV postive mother

0 25 50 75 100

49

53

23

77**

72**

50**

31**

26**

47

48

19

70

63

39

15

16

Baseline (n=560)Endline (n=560)

Percentage**p-value< 0.01; * p-value<0.05

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Fear-Driven Stigma Reduced

Having a meal with an HIV positive individual (food sharing)

Taking care of an HIV positive individual

Carrying an HIV positive individual

Exposed to sweat of an HIV positive individual

Sharing cutlery items with an HIV positive individual

Exposed to saliva of an HIV positive individual

0 25 50 75 100

27*

35

38

34**

44**

56**

33

37

43

45

57

67

Baseline (n=560)Endline (n=560)

Percentage**p-value< 0.01; * p-value<0.05

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Value-Driven Stigma (Shame) Reduced

I would feel ashamed if someone in my family had

HIV

People living with HIV should be ashamed of themselves

I would feel ashamed if I was infected with HIV

0 25 50 75 100

27*

43

56

40

47

65

Baseline (n=560)Endline (n=560)

Percentage**p-value< 0.01; * p-value<0.05

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Percent Exposed to Interventions

Banking day meetings

Campaign

Funfair

At least

1 poster

At least

1 radio drama

At least

1 messa

ge on banking slip

01530456075

1127

18

62 65 59

16

Percent Exposed to Intervention

0

10

20

30

40

50

60

No exposure

Exposure 1

Exposure 2

Exposure 3 (Campaign/Funfair/IEC)Exposure 3 (other com-binations)

Exposure 4

Multivariate Linear Analysis

‡Adjusted for sex, marital status, age, education, residence, personal income, occupation, & media exposure to HIV messaging, baseline community average of fear

Fear-driven stigma β coef. (95% CI)Personally knew a person living with HIV no ref yes -2.59** -4.49 -0.69HIV/AIDS Knowledge 0-3 correct responses ref 4-9 correct responses -4.83** -6.48 -3.19Intervention exposures None or one ref Two -1.09 -3.10 0.91 Three (Campaign/Funfair/IEC) -3.81* -7.33 -0.29 Three (Other combinations) -2.67 -6.30 0.97 Four -0.79 -5.61 4.02Constant 52.93 46.68 59.18**p-value< 0.01; * p-value<0.05

Multivariate Linear Analysis Value-driven stigma (shame) β coef. (95% CI)Personally knew a person living with HIV no ref yes -1.94 -3.85 -0.03HIV/AIDS Knowledge 0-3 correct responses ref 4-9 correct responses -3.79** -5.46 -2.12Intervention exposures None or one Ref Two -0.72 -2.76 1.32

Three (Campaign/Funfair/IEC) -4.26* -7.82 -0.71 Three (Other combinations) -1.10 -4.79 2.58 Four -4.23 -9.11 0.66Constant 51.80 45.88 57.73

‡Adjusted for sex, marital status, age, education, residence, personal income, occupation, & media exposure to HIV messaging, baseline community average of shame

**p-value< 0.01; * p-value<0.05

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Findings• Correct knowledge of HIV improved• Fear and shame reduced• Greater correct HIV knowledge is associated with

lower levels of fear and shame• Personally knowing someone living with HIV is

associated with lower levels of fear but not shame• A combination of interventions for shifting

community level fear and shame– HIV campaigns, Funfairs, IEC materials with key messages

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Conclusions• Involving people living with HIV in every step

of the project• Important to tackle HIV stigma and

discrimination using a combination of approaches

• First step: increase correct HIV knowledge• Thailand HIV & AIDS Strategy 2012-2016

– To reduce HIV stigma and discrimination by half

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Acknowledgements

• Arunee Bunpabut & Nungruthai Mongkolviboonpol, PDA Research and Evaluation Staff

• Urai Homtawee, Malee Sunsiri, & Ekachai Kumissara, PDA Program Staff

• Supol Singhapoom, PACT M&E Officer• Laura Nyblade, RTI International• Department of Population, Family & Reproductive Health, JHSPH• The Bill & Melinda Gates Institute of Population & Reproductive

Health, JHSPH