Acceptability of an Internalized Stigma Reduction Intervention among Women Living with HIV in Tanzania

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ABSTRACT/PROJECT SUMMARY The stigma associated with HIV, especially internalized stigma, yields a number of negative outcomes including non-adherence to antiretroviral therapy, non-engagement in care, poor self-efficacy for disclosure, and a diminished quality of life. Unfortunately, stigma is virtually synonymous with the experience of being a woman living with HIV in Tanzania, East Africa, and around the world. In Tanzania, despite the negative impact of stigma on HIV outcomes, interventions to mitigate the negative effects of internalized stigma associated with HIV, and instruments to measure intervention efficacy, are limited and critically needed. In Tanzania, the site for this study, approximately 810,000 women are living with HIV. Through development and rigorous testing of theoretically grounded, culturally sensitive, linguistically relevant, gender-specific internalized stigma reduction interventions, it is possible to help women successfully self-manage internalized stigma so they can achieve a variety of beneficial psychosocial, behavioral, and clinical outcomes including engaging in care, adhering to ART leading to an improved CD4+ T-cell counts and virologic suppression, and having an optimized quality of life. The internalized stigma reduction intervention to be evaluated for adaptation in this study, Maybe Someday: the Voices of Women Living with HIV, was identified to be effective in reducing internalized stigma among WLWH in the Southern USA. The Maybe Someday intervention, designed to work through the theory of narrative transportation, uses stories to help women understand elements of their own lives. In societies like Tanzania, where storytelling is an important part of the oral literature and culture, the use of stories can be used to help individuals acknowledge and reflect upon new truths in relation to self and their world producing transformations and insights that endure. Thus, the specific aims for this proposed study are to: Aim 1: assess the acceptability, and areas of necessary adaptation, of the internalized stigma reduction intervention, Maybe Someday, designed to mitigate the negative effects of internalized HIV- related stigma among women living with HIV in Tanzania; Aim 2: identify the preferred mode of intervention delivery among women living with HIV in Tanzania; Aim 3: evaluate the cultural and linguistic sensitivity and psychometric properties of a set of adapted measurement instruments essential to determining the efficacy of the Maybe Someday internalized stigma reduction intervention to be adapted for WLWH in Tanzania.