Preventing HIV/AIDS by Building Capacity to Reduce Stigma Among Providers for Pregnant Women in Rural Haiti.

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PROJECT SUMMARY Sabotaging the possibility of an AIDS free generation, stigma continues to undermine primary and secondary prevention efforts in Haiti. Given Haitian women's increased vulnerability for HIV, the possibility of perinatal transmission, and the likelihood of increased contact with healthcare providers during pregnancy, this proposal aims to develop and pilot a culturally relevant multilevel intervention targeted at lessening the influence of stigma in undermining important preventative and treatment seeking behaviors among pregnant Haitian women. The intervention will train providers in healthcare settings and traditional birth attendants (i.e., matrones) in community settings to abate stigmatizing attitudes and behaviors so as to eliminate the negative impact of stigma before it begins. Further, as stigma is a barrier to linking HIV positive pregnant women to care, the secondary goal of this proposal is to enhance the capacity of providers and matrones to introduce and retain women in the HIV care continuum, which includes enhanced linkages to and retention in care. Moving beyond individual level approaches, we will employ a community based participatory research approach to work collaboratively with community based organizations to develop a multi-level stigma reduction intervention based on the Global Stigma Reduction Framework, an adaptable model used to inform development of stigma reduction programming. The intervention will have two components: (1) a healthcare system intervention for providers (i.e., doctors, nurses, and midwives) serving pregnant women and (2) a community-level intervention for matrones. We will develop this intervention through formative research with pregnant women, matrones, community leaders, and maternal health and HIV prevention/treatment clinicians. This research will allow us to gather information about experiences with and drivers of stigma in the community and healthcare system. Using results of the formative research, the intervention will be developed by a working leadership group consisting of HIV prevention experts, healthcare providers, and community members. To obtain information about intervention acceptability, feasibility, satisfaction, and preliminary evidence of improved outcomes, we will conduct a pilot quasi-experimental trial of providers at four healthcare facilities and matrones in the surrounding communities (randomizing 2 clinics/communities to the intervention group and 2 to the control group). Additionally, we will assess the indirect impact of the intervention by conducting serial cross-sectional assessments with pregnant women under the care of providers/matrones in the control and intervention groups. By addressing stigmatizing attitudes and associated behavior in healthcare and community settings, we aim to create an environment that will foster greater utilization of HIV preventive and treatment services in order to reduce HIV risk for pregnant women, their unborn children, and their partners. This innovative research is needed and has potential to provide a model for addressing stigma in other low and middle-income countries (LMICs) to address stigma as a barrier to HIV prevention and treatment.