Feasibility, Acceptability, and Initial Efficacy of the ‘Unity Workshop’:

An Internalized Stigma Reduction Intervention for African-American Women Living with HIV

D. Rao, M. Desmond, M. P. Andrasik, T. Rasberry, N. Lambert, S. E. Cohn, J. M. Simoni

Conceptual Model

Public Level

Individual Level

Race

Gender

HealthCondition(s)

InternalizedStigma

PoorTreatmentUtilization

PoorHealth

Outcomes

Culture(Social norms, shared beliefs about body, health & illness, power structures)

PublicStigma

InstitutionalizedStigma

1Rao et al., 2007 2Rao et al., 2011

Race

Gender

(OtherStatuses)

PoorTreatmentUtilization

Culture(Social norms, power structures, shared beliefs about body, health & illness,)

PublicStigma

InstitutionalizedStigma

Reducing HIV/AIDS Stigma• Societal level1

– Removal of institutional stigmas– Microfinance programs (economic empowerment)– Community organizing

• Individual level2,3

– Education/Information– Coping Skills Acquisition– Contact with Affected Persons (e.g. Social Support)

1Link & Phelan, 2001; 2 Brown, Trujillo, Macintyre, 2001; 3Corrigan, 2011

• HIV Stigma Toolkit developed by International Center for Research on Women (ICRW)1 – Developed in Zambia, facilitators trained globally– We chose from 40+ exercises based on focus groups

feedback

• We developed ‘trigger videos’ from Toolkit scenarios/focus group content in order to – model proactive behaviors – trigger discussion

ICRW HIV Stigma Toolkit

1Kidd, Clay, Chiiya, 2007

The Unity Workshop

• Piloted as 8-hour workshop across 2 afternoons

• Peer facilitated• Group setting• Participants

– 24 African American women living with HIV– Living with HIV from 3 months to 25 years

Content Examples

• “Group Expectations” (e.g. Mutual Respect, No right or wrong answers)

• Personal Experiences of Stigma• Coping with Stigma (sharing methods)• Role play – navigating stigmatizing situations

Web of String represented “Peace,” “Unity,” “Togetherness”

Methods• Pre-test post-test design• Paired t-tests• Primary outcome: Stigma Scale for Chronic

Illness (SSCI), 14 item scale adapted for African-Americans living with HIV1

1Rao, Choi, et al., 2009; Rao, Molina, et al., under review

Results

Baseline Day 2 Day 3 Day 4 Day 5 Day 6 Day 7 Day 80tan29a566029

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Average Stigma Scores (24 attendees)

Day 1 to 2: t=2.05 (df=20), p=0.054Day 1 to Day 8: t=1.95 (df=18), p=0.067

Limitations/Future Directions• No control group• Trends/non-significance likely related to small

sample size• Booster session potentially helpful• Next step: randomized clinical trial

Thank You!• Our Participants• Tom Furtwangler (Video Producer), James and

Margaret Longley (Camera and Sound), Yamile Molina (Scripting)

• NIH K23 MH 084551

Questions? deeparao@uw.edu