Designing an Ethnodrama Intervention Addressing PrEP Stigma Toward Young Women

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PROJECT SUMMARY Innovative interventions that support young cisgender women’s (YCW) use of PrEP are critically needed. Adolescent girls and young women (AGYW) in sub-Saharan Africa continue to have disproportionately high HIV incidence, particularly AGYW in Siaya County, Kenya. Existing intrapersonal-, interpersonal-, and clinic- level PrEP interventions will likely be more successful when embedded within supportive environments where prevailing social norms encourage YCW’s use of PrEP and normalize, rather than stigmatize, its use. Findings from our recent R21 highlight the negative impact on YCW’s PrEP use due to PrEP-related stigma by communities members, suggesting a need for broader-level interventions. The purpose of this R01 is to develop, pre-test, and pilot a community-level, ethnodrama intervention designed to transform community member beliefs about and foster support of YCW’s PrEP use, thereby reducing enacted PrEP-related stigma toward YCW and anticipated and internalized stigma among YCW. In Aim 1, we will develop the ethnodrama intervention. The Eldoret Film Festival, a Kenya-based drama group, together with Theater Delta, a U.S.-based organization focused on fostering social change through interactive theater, will use our R21 findings to create a series of ethnodrama performances designed to change the narrative on YCW’s PrEP use. In Aim 2, we will pre-test the ethnodrama intervention with YCW who have taken/are taking PrEP, female peers of YCW, male partners of YCW, healthcare providers, informal community leaders, and family members of YCW (n=60). During two rounds of pre-testing, we will assess the acceptability of the ethnodrama’s storylines and interactive components through small group discussions and explore the intervention’s effect on transforming participants’ PrEP-related perceptions using a validated Narrative Transportation Scale (NTS) and other assessments. In Aim 3, we will publicly pilot the ethnodrama intervention in its entirety in multiple areas in one sub-county of Siaya, focusing on assessing the feasibility of implementing the ethnodrama intervention and exploring the intervention’s perceived effectiveness on transforming beliefs, creating support of YCW’s PrEP use, and reducing stigma. Among a study cohort of YCW who have taken/are taking PrEP (n=20), we will administer a validated PrEP-related stigma scale pre-pilot, immediately post-pilot, and 3 months post-pilot and conduct in- depth interviews (IDIs) to explore responses to the PrEP stigma scale and perceptions of the intervention’s potential impact on reducing PrEP-related stigma. We will also administer the NTS and other assessments with randomly-selected audience members (n=20) for each performance, and administer the NTS and other assessments, including IDIs on the intervention’s potential impact on reducing PrEP-related stigma, with a community member study cohort (n=20), immediately post-pilot. By achieving our study aims, we will have the experience to rapidly initiate and implement the ethnodrama intervention on a larger scale in a subsequent effectiveness R01 that will measure its effect on PrEP adherence and persistence among YCW.