Acceptability of an Internalized Stigma Reduction Intervention among Women Living with HIV in Tanzania

摘要/项目摘要 与艾滋病毒有关的耻辱，特别是内在化的耻辱，产生了一些负面后果 包括不坚持抗逆转录病毒治疗，不参与护理，对 披露，以及生活质量的下降。不幸的是，耻辱实际上是 在坦桑尼亚、东非和世界各地作为艾滋病毒携带者的妇女的经历。在坦桑尼亚， 尽管耻辱对艾滋病毒结果产生负面影响，但减轻负面影响的干预措施 与艾滋病毒相关的内在化污名以及衡量干预效果的工具是 有限而迫切需要的。在这项研究的所在地坦桑尼亚，大约有810,000名妇女生活在 艾滋病毒携带者。通过开发和严格测试理论上站稳脚跟、文化敏感、语言上 相关的、针对性别的内化耻辱减少干预措施，有可能帮助妇女 成功地自我管理内化的耻辱，这样他们就可以实现各种有益的心理社会， 行为和临床结果，包括参与护理，坚持抗逆转录病毒疗法，从而改善CD4+ T细胞计数和病毒学抑制，并具有优化的生活质量。内化的耻辱 在这项研究中，也许有一天，减少干预措施将被评估为适应：女性的声音 艾滋病毒携带者，被证实有效地减少了南方WLWH的内在化耻辱 美国。也许有一天干预，旨在通过叙事性运输理论工作，使用 帮助女性了解自己生活元素的故事。在像坦桑尼亚这样的社会，讲故事是 作为口头文学和文化的重要组成部分，故事的使用可以用来帮助个人 承认和反思与自我及其世界有关的新真理，产生转化和 经久不衰的洞察。因此，这项拟议研究的具体目标是： 目标1：评估内在化污名减少的可接受性和必要的适应领域 干预，也许有一天，旨在减轻内在化的艾滋病毒相关耻辱的负面影响 在坦桑尼亚感染艾滋病毒的妇女中； 目标2：确定坦桑尼亚艾滋病毒携带者妇女首选的干预提供方式； 目标3：评估一组适应的文化和语言敏感性以及心理测量学特性 测量仪器对于确定也许有一天内化的污名的有效性是必要的 减少干预措施将适用于坦桑尼亚的WLWH。

ABSTRACT/PROJECT SUMMARY The stigma associated with HIV, especially internalized stigma, yields a number of negative outcomes including non-adherence to antiretroviral therapy, non-engagement in care, poor self-efficacy for disclosure, and a diminished quality of life. Unfortunately, stigma is virtually synonymous with the experience of being a woman living with HIV in Tanzania, East Africa, and around the world. In Tanzania, despite the negative impact of stigma on HIV outcomes, interventions to mitigate the negative effects of internalized stigma associated with HIV, and instruments to measure intervention efficacy, are limited and critically needed. In Tanzania, the site for this study, approximately 810,000 women are living with HIV. Through development and rigorous testing of theoretically grounded, culturally sensitive, linguistically relevant, gender-specific internalized stigma reduction interventions, it is possible to help women successfully self-manage internalized stigma so they can achieve a variety of beneficial psychosocial, behavioral, and clinical outcomes including engaging in care, adhering to ART leading to an improved CD4+ T-cell counts and virologic suppression, and having an optimized quality of life. The internalized stigma reduction intervention to be evaluated for adaptation in this study, Maybe Someday: the Voices of Women Living with HIV, was identified to be effective in reducing internalized stigma among WLWH in the Southern USA. The Maybe Someday intervention, designed to work through the theory of narrative transportation, uses stories to help women understand elements of their own lives. In societies like Tanzania, where storytelling is an important part of the oral literature and culture, the use of stories can be used to 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 acceptability, and areas of necessary adaptation, of the internalized stigma reduction intervention, Maybe Someday, designed to mitigate the negative effects of internalized HIV- related stigma among women living with HIV in Tanzania; Aim 2: identify the preferred mode of intervention delivery among women living with HIV in Tanzania; Aim 3: evaluate the cultural and linguistic sensitivity and psychometric properties of a set of adapted measurement instruments essential to determining the efficacy of the Maybe Someday internalized stigma reduction intervention to be adapted for WLWH in Tanzania.