An Intervention to Reduce HIV-Related Stigma Among

African American Communities in South

Carolina

John B. Pryor, Ph.D.

Department of Psychology

Illinois State University

Bambi Gaddist, DrPH

South Carolina HIV/AIDS Council

Letitia Johnson-Arnold, MSPH

South Carolina HIV/AIDS Council

6/13/2005, 3:30-5:00 PM

Session Number:M3-C17-05, Location:Embassy-Hong Kong

Funded by the Academy for Educational Development

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Presentation at thePresentation at the

2005 National HIV Prevention 2005 National HIV Prevention ConferenceConference

1. Background - HIV in South Carolina• South Carolina HIV/AIDS Council

2. General Survey 2003-2004• Some comparisons of the General Survey to a

national probability sample• A conceptual model of stigma

3. An Intervention Evaluation• No evidence for an immediate impact of the

intervention• Implications of intervention survey for factors

affecting stigma avoidance• Some connections between stigma and

prevention behavior

Outline of Today’s Talk

Background

• Approximately 201 of every 100,000 adults and adolescents in South Carolina are living with HIV and another 185 per 100,000 are living with AIDS (CDC, 2003).

• The number of AIDS cases among African Americans in South Carolina is higher than that among any other ethnic/racial group.

• The prevalence among Blacks is ten times that of Whites in South Carolina (CDC, 2004).

South Carolina HIV/AIDS Council

Three-prong initiative to reduce HIV-related stigma among African American communities throughout South Carolina:– Organizing educational town hall meetings in rural

communities– Developing and staging an educational theatre

production concerning HIV/AIDS stigma and discrimination

– A statewide media campaign

• Survey instrument was based upon national telephone surveys conducted by Herek and his colleagues in 1991, 1997, & 1999 (Herek, Capitanio, & Widaman, 2002)

• SCHAC General Survey sample was recruited from attendees at town hall meetings and theatrical performances organized by SCHAC

• Herek 1999 national probability sample: 669 adults

• SCHAC 2003-2004 sample: 403 African American adults in South Carolina

General Survey 2003-2004

Bars in pink represent 95% confidence intervals for national probability survey

Avoidant Intentions

8.5

9.1

29.3

20.1

56

22.7

25

19.4

26.9

0 10 20 30 40 50 60

Suppose you found out that the pastor of yourchurch had HIV/AIDS.

Suppose you found out that the pastor of yourchurch was homosexual.

Suppose you found out that a fellow Bible study orprayer partner had HIV/AIDS.

Suppose you had a young child who was attendingschool where one of the students was known to have

HIV/AIDS.

Suppose you worked in an office where someoneworking with you developed HIV/AIDS.

Suppose you found out that the owner of a smallneighborhood grocery store where you liked to shop

had HIV/AIDS.

percent who would avoid

CI-2.5% Herek Survey CI+2.5% SCHAC Survey

SC

HA

C s

urv

ey

item

s n

ot

in H

ere

k su

rve

y

more avoidance

Responsibility and Blame for HIV Infection

21.5

44.5

24.8

48.3

28.1

52.1

8

29

0 10 20 30 40 50 60

People who got HIV/AIDSthrough sex or drug use

have gotten what theydeserve.

Most people withHIV/AIDS are responsible

for having got theirillness.

Percent responding "agree' or "strongly agree"

CI-2.5% Herek Survey CI+2.5% SCHAC Survey

Bars in pink represent 95% confidence intervals for national probability survey

Bars in pink represent 95% confidence intervals for national probability survey

Misconceived HIV Transmission Beliefs

11.5

46.3

37.1

46.6

29.3

13.3

50.1

40.8

50.4

32.9

15.1

53.9

44.5

54.2

36.5

30.6

49.9

54.5

44.1

71.6

0 10 20 30 40 50 60 70 80

Kissing someone on thecheek that has HIV/AIDS.

Sharing a drink out of thesame glass with someone

who has HIV/AIDS.

Using public toilets

Being coughed on orsneezed on by someone

who has HIV/AIDS.

Donating or giving blood

Percent who believe in some likelihood of transmission

CI-2.5% Herek Survey CI+2.5% SCHAC Survey

more misconceptions

Level of Comfort with Persons who have HIV/AIDS

66.2

74.4

69.4

71

69.7

77.6

72.8

74.3

72.2

80.8

76.2

77.5

66

77.6

69.3

53

0 10 20 30 40 50 60 70 80 90

A child in your family attending school with a personwho has HIV/AIDS

Working with an office co-worker who has HIV/AIDS

Having a neighborhood grocer who has HIV/AIDS

Drinking out of a washed glass in a restaurant ifsomeone with HIV/AIDS had drunk out of the same

glass a few days earlier

Percent feeling comfortable

CI-2.5% Herek Survey CI+2.5% SCHAC Survey

Bars in pink represent 95% confidence intervals for national probability survey

Negative Feelings toward PWAs

12.1

17.1

13.2

14.8

20.2

16

17.5

23.2

18.8

10.8

16.6

13.7

0 5 10 15 20 25

Angry

Afraid

Disgusted (sickened)

Percent responding "agree" or "somewhat agree"

CI-2.5% Herek Survey CI+2.5% SCHAC Survey

Bars in pink represent 95% confidence intervals for national probability survey

Summary

Compared to the national probability sample, the SCHAC sample of African American adults in SC– Displayed more avoidant intentions in 2 out of 3

measures– Were less likely to blame PLWHA– Displayed more misconceptions about

transmission in 3 out of 5 measures– Indicated much less comfort with PLWHA in only 1

out of 4 measures– Indicated somewhat less negative emotions in 2

out of 3 measures

A conceptual model of HIV-related

stigma

Conceptual Model of Psychological Reactions to Stigma

CognitiveResponses

Approach/AvoidanceBehaviors

EmotionalReactions

AvoidanceAvoidanceof PLWHAof PLWHA

Comfort-Comfort-PLWHAPLWHA

Negative Negative Emotions-Emotions-

PLWHAPLWHA

BlameBlame

Belief inBelief inCasual Casual ContactContact

Cognitive Affective Behavioral

Components of Stigma in General Survey

AvoidanceAvoidanceof PLWHAof PLWHA

ß=.26*

ß=.34*

ß=-.43*

ß=.29*

Step 1Step 2

R2=.25,F(2,367)=59.65,

p<.01

R2=.49,Fchange(2,365)=85.46,

p<.01 *p<.05

Hierarchical MultipleRegression PredictingAvoidance Intentions

BlameBlame

Belief inBelief inCasual Casual ContactContact

Comfort-Comfort-PLWHAPLWHA

Negative Negative Emotions-Emotions-

PLWHAPLWHA

STUDY 1

AvoidanceAvoidanceof PLWHAof PLWHA

Comfort-Comfort-PLWHAPLWHA

Negative Negative Emotions-Emotions-

PLWHAPLWHA

Belief inBelief inCasual Casual ContactContact

BlameBlameß=-.48*

ß=.30*

ß=.04

ß=.11*

Step 1Step 2

R2=.48,F(2,367)=166.76,

p<.01

R2=.49,Fchange(2,365)=3.51,

p<.01 *p<.05

Hierarchical MultipleRegression PredictingAvoidance Intentions

STUDY 1

Summary

• Avoidance intentions are related to both cognitive and affective components of stigma

• Affective components seem to account for more unique variance in avoidance intentions

An intervention evaluation

Intervention• Play about HIV

infection in African American families

• Themes:– Forgiveness– Family support– Tolerance– It could happen to you

Design of Intervention Evaluation

RandomAssignment

RecruitmentFrom the

African AmericanCommunity

Delay Play Discussion Survey

Survey Play Discussion

Constructs Measured in the Intervention Survey

• Empathy for persons living with HIV/AIDS (PLWHA) (Empathy for persons living with HIV/AIDS (PLWHA) (.82).82)• Negative emotions for PLWHA (Negative emotions for PLWHA (.77).77)• Blame (Blame (.50).50)• Beliefs in transmission via causal contact (Beliefs in transmission via causal contact (.82).82)• Avoidance tendencies regarding PLWHA (Avoidance tendencies regarding PLWHA (.82).82)• Attitudes about being tested (Attitudes about being tested (.89).89)• Motivation to control prejudice regarding PLWHA (Motivation to control prejudice regarding PLWHA (.79).79)• Superstitious contagion beliefs (Superstitious contagion beliefs ())• Attitudes toward MSM and WSW (Attitudes toward MSM and WSW (.87, .87, .93).93)• Personal contact with MSM and WSW (Personal contact with MSM and WSW ())• Positive religious beliefs regarding PLWHA (Positive religious beliefs regarding PLWHA (.67).67)• Support for coercive social policies (Support for coercive social policies (.80).80)

Summary of the Analyses from the Intervention Survey

• There were no statistically significant differences between There were no statistically significant differences between the two intervention conditions across any of the the two intervention conditions across any of the constructsconstructs

• Participants in intervention study were from Richland County Participants in intervention study were from Richland County (pop=334,609)(pop=334,609)

• 3/4 of General Survey sample were from counties with less than 3/4 of General Survey sample were from counties with less than 100,000 population100,000 population

• Comparisons between measures common across the Comparisons between measures common across the Intervention Survey and the General Survey revealed that Intervention Survey and the General Survey revealed that participants in the intervention participants in the intervention blamed PLWHAs lessblamed PLWHAs less than than people from counties less than 100,000; they also indicated people from counties less than 100,000; they also indicated weaker avoidance intentionsweaker avoidance intentions than people from counties less than people from counties less than 100,000than 100,000

• Ironically, participants in the intervention displayed certain Ironically, participants in the intervention displayed certain negative emotions morenegative emotions more than all others from the General Survey than all others from the General Survey

Examining the HIV-related stigmaconceptual model

AvoidanceAvoidanceof PLWHAof PLWHA

Empathy-Empathy-PLWHAPLWHA

Negative Negative Emotions-Emotions-

PLWHAPLWHA

BlameBlame

Belief inBelief inCasual Casual ContactContact

Cognitive Affective Behavioral

Components of Stigma in Intervention Survey

AvoidanceAvoidanceof PLWHAof PLWHA

ß=.22†

ß=.07

ß=-.23*

ß=.33*

Step 1Step 2

R2=.06,F(2,72)=2.16,

P=.12

R2=.19,Fchange(2,70)=5.85,

p<.01 *p<.05†p<.07

Hierarchical MultipleRegression PredictingAvoidance Intentions

BlameBlame

Belief inBelief inCasual Casual ContactContact

Empathy-Empathy-PLWHAPLWHA

Negative Negative Emotions-Emotions-

PLWHAPLWHA

STUDY 2

AvoidanceAvoidanceof PLWHAof PLWHA

Empathy-Empathy-PLWHAPLWHA

Negative Negative Emotions-Emotions-

PLWHAPLWHA

Belief inBelief inCasual Casual ContactContact

BlameBlameß=-.24*

ß=.35*

ß=.05

ß=-.01

Step 1Step 2

R2=.19,F(2,72)=8.41,

p<.01

R2=.19,Fchange(2,70)<1,

NS *p<.05

Hierarchical MultipleRegression PredictingAvoidance Intentions

STUDY 2

Summary

• Affective components were more strongly related to variance in avoidance intentions than cognitive components of stigma

Why should prevention

researchers be concerned with HIV-

related stigma?

Attitude Attitude Toward HIVToward HIV

TestingTesting

ß=-.30*

ß=.11

ß=.38*

ß=.01

Step 1Step 2

R2=.09,F(2,77)=3.34

P<.05

R2=.22,Fchange(2,75)=6.21,

p<.01 *p<.05

Hierarchical MultipleRegression PredictingAttitudes toward HIVTesting

BlameBlame

Belief inBelief inCasual Casual ContactContact

Empathy-Empathy-PLWHAPLWHA

Negative Negative Emotions-Emotions-

PLWHAPLWHA

STUDY 2

Attitude Attitude Toward HIVToward HIV

TestingTesting

Empathy-Empathy-PLWHAPLWHA

Negative Negative Emotions-Emotions-

PLWHAPLWHA

Belief inBelief inCasual Casual ContactContact

BlameBlameß=.43*

ß=-.04

ß=.-.19

ß=.06

Step 1Step 2

R2=.19,F(2,77)=8.88,

p<.01

R2=.22,Fchange(2,75)=1.47,

NS *p<.05

Hierarchical MultipleRegression PredictingAttitudes toward HIVTesting

STUDY 2

Summary

• Empathy for PLWHAs was a relatively strong predictor of attitudes toward testing

• People who felt empathy/compassion for PLWHAs held more positive attitudes toward being tested themselves or encouraging their family & friends to be tested

Future Directions

• Our analyses of survey data suggest that anti-stigma interventions might focus upon encouraging empathy for PLWHAs

• Interventions that encourage empathy/compassion for PLWHAs may also have an impact upon attitudes toward HIV testing

• A focus upon empathy/compassion may be well received in faith communities

Special thanks to the following people who Special thanks to the following people who helped in data analyses for this projecthelped in data analyses for this project

• Jamie HughesJamie Hughes• Leah PryorLeah Pryor

Variables1 2 3 4 5 6 7 8

1 Avoidant Intentions 1.00 -0.28 0.34 0.11 0.25 -0.11 -0.20 0.052 Empathy toward PLWHA -0.28 1.00 -0.09 0.11 -0.27 0.44 0.36 0.113 Negative Emotions toward PLWHA 0.34 -0.09 1.00 0.31 0.42 -0.08 -0.22 0.064 Misconceptions about Transmission 0.11 0.11 0.31 1.00 0.13 0.05 -0.11 0.055 Blame 0.25 -0.27 0.42 0.13 1.00 -0.31 -0.37 -0.076 Attitudes about Being Tested -0.11 0.44 -0.08 0.05 -0.31 1.00 0.21 0.047 Motivations to Control Prejudice -0.20 0.36 -0.22 -0.11 -0.37 0.21 1.00 -0.018 Contamination Sensitivity 0.05 0.11 0.06 0.05 -0.07 0.04 -0.01 1.009 Pro-HIV Religious Values -0.21 0.26 -0.17 0.00 -0.12 0.17 0.28 -0.15

10 Attitudes toward MSM -0.32 0.22 -0.37 -0.33 -0.16 -0.06 0.21 -0.0211 Endorsing Coercive Social Policies 0.40 -0.22 0.50 0.35 0.61 -0.20 -0.52 -0.0812 Age 0.14 0.27 0.17 0.07 -0.12 -0.03 -0.09 -0.0613 Gender 0.06 0.09 0.11 0.24 -0.14 0.21 -0.10 0.0614 Income Level 0.12 0.05 -0.04 -0.19 -0.08 -0.05 0.01 -0.1415 Church Attendance -0.09 -0.02 0.06 -0.01 0.22 -0.06 -0.05 -0.18

9 10 11 12 13 14 151 Avoidant Intentions -0.21 -0.32 0.40 0.14 0.06 0.12 -0.092 Empathy toward PLWHA 0.26 0.22 -0.22 0.27 0.09 0.05 -0.023 Negative Emotions toward PLWHA -0.17 -0.37 0.50 0.17 0.11 -0.04 0.064 Misconceptions about Transmission 0.00 -0.33 0.35 0.07 0.24 -0.19 -0.015 Blame -0.12 -0.16 0.61 -0.12 -0.14 -0.08 0.226 Attitudes about Being Tested 0.17 -0.06 -0.20 -0.03 0.21 -0.05 -0.067 Motivations to Control Prejudice 0.28 0.21 -0.52 -0.09 -0.10 0.01 -0.058 Contamination Sensitivity -0.15 -0.02 -0.08 -0.06 0.06 -0.14 -0.189 Pro-HIV Religious Values 1.00 0.17 -0.19 -0.01 -0.03 -0.02 -0.01

10 Attitudes toward MSM 0.17 1.00 -0.30 0.07 -0.10 0.03 -0.1811 Endorsing Coercive Social Policies -0.19 -0.30 1.00 0.20 -0.08 0.01 0.1012 Age -0.01 0.07 0.20 1.00 0.08 0.31 0.0713 Gender -0.03 -0.10 -0.08 0.08 1.00 -0.10 -0.0614 Income Level -0.02 0.03 0.01 0.31 -0.10 1.00 -0.0515 Church Attendance -0.01 -0.18 0.10 0.07 -0.06 -0.05 1.00

Correlation Matrix from Intervention Study

Correlations in yellow are statistically significant, p < .05