Exploring the Impact of Illness Identity on Intersectional Stigma Through the Care Continuum

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PROJECT SUMMARY Tuberculosis (TB) and HIV stigma causes significant morbidity and mortality in South Africa. Despite curative treatments for TB and antiretroviral therapies that suppress HIV viral load, both diseases continue to spread in low- and middle-income countries. Stigma is a significant barrier to care engagement and treatment adherence for HIV and TB. Intersectional stigma theory acknowledges the infinite combination of identities that contribute to stigma and social erasure. However, this wholistic approach of social constructs is not easily translated into measurement science. The applicant's proposed study, Exploring the Impact of Illness Identity on Intersectional Stigma Through the Care Continuum, will address this gap. The purpose of this project is to explore intersectional TB/HIV stigma through the care continuum to determine whether HIV viral suppression, and TB culture/smear conversion represent changes in illness identity that mitigate stigma. Aim 1 will quantify TB/HIV stigma using the Van Rie Patient Perspectives on TB/HIV Scales and use repeated measures ANOVA to evaluate significance in changes of stigma over time. In Aim 2, the applicant will use in-depth qualitative interviews to explore nuance and variation of intersectional stigma throughout the care continuum as experienced by people living with TB and HIV in South Africa that may not be captured within the Van Rie Scales. From the qualitative interviews, the applicant will develop and pilot four to five additional instrument items to address the overlap in TB/HIV stigma that is not captured within the parallel items of the Van Rie Scales. Finally, in aim 3, the applicant will interpret and integrate the qualitative and quantitative data to create a deeper understanding of intersectional TB/HIV stigma in South Africa and to assess its impact on treatment engagement across the care continuum. The applicant will use data from this proposal to improve the accuracy of stigma measurement in South Africa. This study will lay the foundation for future career in global stigma analysis and intervention work. It is therefore, an important first step in an exciting program of research to reduce stigma and improve TB and HIV treatment outcomes for global populations.