Efficacy Testing of a Culturally Relevant Stigma Intervention in WLWH in Tanzania

摘要/项目总结 与艾滋病毒有关的污名化，特别是内化的污名化，会产生若干负面后果。据联合国艾滋病规划署称， 只有62%的坦桑尼亚艾滋病毒感染者受到病毒学抑制，性别不平等和艾滋病毒相关 污名化是主要障碍。尽管污名化对艾滋病毒结果产生负面影响，但文化和 对背景敏感的干预措施，以减轻与艾滋病毒/艾滋病相关的 在坦桑尼亚，妇女艾滋病毒感染者中的艾滋病毒感染者人数有限，而且迫切需要。 在坦桑尼亚，80%的人口生活在农村地区，艾滋病毒是导致艾滋病的第三大原因。 死亡，估计有810 000名妇女感染艾滋病毒。4.5%的坦桑尼亚15岁以下成年人 艾滋病毒感染者49人，妇女感染率较高（艾滋病毒/艾滋病感染者= 5.5%：艾滋病毒/艾滋病感染者= 3.4%）。 此外，艾滋病毒感染率在45 - 49岁妇女中最高，为12%（而45 - 49岁妇女为8.4%）。 这个年龄的人）。此外，年轻妇女的新感染率过高， 在坦桑尼亚（15 - 24岁），与同龄男性相比，2016 - 2017年坦桑尼亚 影响调查发现，15岁至39岁的妇女有可能是 艾滋病毒感染者的比例。因此，在招募WLWH参与本研究时，我们将有目的地 根据地理位置（城市和农村）进行招聘，并确保各个年龄段的妇女、家庭和健康状况都充分 代表。 Labda Siku Moja：Sauti za Wanawake Wanaoishi na VVU（Maybe Someday：Voices of Women Living with 艾滋病毒），被确定为一种文化上可接受的内化的减少耻辱感的干预措施， 坦桑尼亚WLWH。在坦桑尼亚，讲故事是口头文学和文化的重要组成部分， Labda Siku Moja的故事可以帮助个人认识和反思与自我有关的新真理 他们的世界产生了持久的变革和见解。因此，本文提出的具体目标是： 研究目的是： 目标1：评估可行性（招募和保留指标;给药时间和研究的完整性 工具;对干预的忠诚度;对研究过程的评估） 在坦桑尼亚城市和农村妇女、妇女和健康者中采取减少干预措施; 目的2：测试初步疗效，并确定内化污名减少干预的效果大小 在城市和农村WLWH（N = 160）中使用2x4重复测量随机对照试验（2 治疗x 4个时间点[基线，30天，90天，180天]），以确定Labda Siku Moja 干预措施减少了耻辱感，提高了自尊和应对自我效能（近端目标）。

ABSTRACT/PROJECT SUMMARY HIV-related stigma, especially internalized stigma, yields several negative outcomes. According to UNAIDS, only 62% of Tanzanians living with HIV are virologically suppressed, with gender inequality and HIV-related stigma acting as major barriers. Despite the negative impact of stigma on HIV outcomes, culturally and contextually sensitive interventions to mitigate the negative effects of internalized stigma associated with HIV among women living with HIV (WLWH) are limited and critically needed in Tanzania. In Tanzania, where 80% of the population lives in rural areas and HIV is the third leading cause of death, an estimated 810,000 women are living with HIV. 4.5% of Tanzanian adults between the ages of 15 and 49 were living with HIV with the prevalence being higher among women (♀ = 5.5%:♂=3.4%). Additionally, the prevalence of HIV is highest among women aged 45-49, at 12% (compared with 8.4% among men of this age). Further, there are disproportionate rates of new infections among young women in Tanzania (ages 15-24) compared to their male counterparts of the same age. The 2016-2017 Tanzania Impact Survey identified that women between the ages of 15 and 39 are more than twice as likely to be living with HIV as their male counterparts. Thus, in recruiting WLWH for this study, we will purposively recruit based on geography (urban and rural) and ensure that WLWH across the age spectrum are sufficiently represented. Labda Siku Moja: Sauti za Wanawake Wanaoishi na VVU (Maybe Someday: Voices of Women Living with HIV), was identified as a culturally acceptable internalized stigma reduction intervention among Tanzanian WLWH. In Tanzania, where storytelling is an important part of the oral literature and culture, the stories of the Labda Siku Moja can 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 feasibility (recruitment and retention metrics; time to administer and completeness of study instruments; fidelity to intervention; evaluation of study processes) of implementing an internalized stigma reduction intervention among urban and rural Tanzanian WLWH; and Aim 2: Test preliminary efficacy and determine effect sizes of an internalized stigma reduction intervention among urban and rural WLWH (N = 160) using a 2x4 repeated measures randomized controlled trial (2 treatments x 4 time points [baseline, 30 days, 90 days, 180 days]) to determine if the Labda Siku Moja intervention results in reduced stigma and improved self-esteem and coping self-efficacy (proximal targets).