Sustainable Development for Improved HIV Health and Prevention in Kenya (SD4H-Kenya)

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PROJECT SUMMARY/ABSTRACT Older women form the largest group of older people (50+ years) living with HIV (OPLWH) and suffer poorer mental health and quality of life than older men. The experiences of stigma are layered for older women living with HIV including HIV- and aging-related stigma and gender discrimination. Widowed women make up the largest group of OPLWH and due to heightened gender inequalities and the stigmatization of female widowhood in Africa, widowed women living with report poorer HIV-related health outcomes compared to married women living with HIV. This study will compare the experience of intersectional stigma (HIV, aging, gender, poverty, widowhood) among older widowed and married women living and aging with HIV, how this impacts their mental health and quality of life, and their ideas on interventions that can reduce intersectional stigma and improve their quality of life. This study will also assess the association of experienced intersectional stigma with mental health and quality of life, and how these may differ between widowed and married women with HIV aged 50+ years. The project lead, Ms. Odhiambo, is doctoral candidate at Maseno University and a Ph.D. fellow in the parent grant Sustainable Development for HIV Health (SD4H) training program. SD4H aimed to provide training and team mentorship to graduate students at Maseno. Ms. Odhiambo completed her year-long Advanced Training in Clinical Research certificate at University of California San Francisco (UCSF) and is doing field work for her PhD project in Kenya. Her soon to be published study showed that a multisectoral intervention failed to address experiences of enacted stigma among widows living with HIV, necessitating further research on stigma among women living with HIV and interventions to address the stigma. Ms. Odhiambo’s work is built upon the theory of stigma as a fundamental cause of population health disparities. Stigma creates a loss of social and economic resources, increasing food insecurity, poverty, and poor health. Strengths and innovation: This supplement study is among the first evaluating the association of experienced intersectional stigma and quality of life among older women living with HIV in Africa. Secondly, we will adapt the everyday discrimination scale (EDS), another scale developed in the USA context and use it in the local Kenyan context to measure experienced intersectional stigma. The design of EDS is adaptable and allows for measurement of different forms of stigma. Thirdly, we will sample study participants from a population-based health and demographic surveillance system ensuring study participants are a representative sample of the general population of women living with HIV and aged 50+ years. This administrative supplement will support Ms. Odhiambo’s transition from doctoral to post-doctoral studies while still receiving the team mentorship from the parent grant multiple principal investigators. The study will also generate ideas on interventions to address intersectional stigma that Ms. Odhiambo can further develop and test in future grant. Ms. Odhiambo is on a path to becoming the next generation of HIV researchers with transdisciplinary expertise in public health, HIV health, and development sciences and this supplement application will support her development.