To determine the efficacy of using a narrative-based intervention to reduce HIV stigma among members of the general public in a rural community in Ecuador.
Design:
This cross-sectional intervention study involved a convenience sample of 133 participants from Cariamanga, Ecuador. We used a post-test only comparison group design.
Setting:
The number of adults living with HIV in Ecuador is increasing. Stigma and discrimination are among the greatest barriers to HIV prevention, access to treatment, care and support. Stigma is also associated with negative health outcomes. The study took place in the rural community of Cariamanga, Loja, Ecuador.
Method:
The intervention included (1) a fact-based presentation, (2) video stories from two individuals living with HIV and (3) a structured group discussion. Data were collected using an HIV Stigma Scale and an HIV Knowledge Assessment. Data were analysed using independent t-test and multivariate analysis of variance (MANOVA).
Results:
Participants who received the intervention had higher HIV knowledge scores (p < .001; d = 2.06) and lower stigma scores (0.59) subsequent to the intervention than the comparison group (1.02, p < .001; d = 1.05).
Conclusion:
This narrative-based educational intervention was effective in reducing HIV-related stigma. Public health practitioners should consider including narratives as a component of future health education interventions aimed at reducing HIV-related stigma.
BarbourJDoshiMHernándezL (2016) Telling global public health stories: Narrative message design for issues management. Communication Research43: 810–843.
2.
BeckmanALWilsonMMPrabhuV, et al. (2016) A qualitative view of the HIV epidemic in coastal Ecuador. PeerJ4: e2726.
3.
BekaluMAEggermontSRamanadhanS, et al. (2014) Effect of media use on HIV-related stigma in Sub-Saharan Africa: A cross-sectional study. PLoS ONE9(6): e100467.
4.
CabezasMCFornasiniMDardenneN, et al. (2013) A cross-sectional study to assess knowledge about HIV/AIDS transmission and prevention measures in company workers in Ecuador. BMC Public Health13(1): 139.
5.
CareyMPSchroderKE (2002) Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Educ Prev14(2):172–182.
6.
CarpenterCJ (2010) A meta-analysis of the effectiveness of health belief model variables in predicting behavior. Health Communication25(8): 661–669.
DearbornJLLewisJMinoGP (2010) Preventing mother-to-child transmission in Guayaquil, Ecuador: HIV knowledge and risk perception. Glob Public Health5(6):649–662.
10.
DeroseKPKanouseDEBogartLM, et al. (2016) Predictors of HIV-related stigmas among African American and Latino religious congregants. Cultural Diversity & Ethnic Minority Psychology22(2): 185–195.
11.
EarlC (2016) Ecuador health professionals perceived knowledge and beliefs about HIV and the use of standard precautions: A cross-sectional descriptive research study. International Journal of Nursing & Clinical Practices3: 169.
12.
EarnshawVAChaudoirSR (2009) From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior13(6): 1160–1177.
EwartCK (1991) Social action theory for a public health psychology. American Psychologist46(9): 931–946.
15.
GilbertLWalkerL (2010) ‘My biggest fear was that people would reject me once they knew my status . . .’: Stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg, South Africa. Health & Social Care in the Community18(2): 139–146.
16.
GreenMC (2006) Narratives and cancer communication. Journal of Communication56(s1): S163–S183.
17.
GreenMCBrockTC (2000) The role of transportation in the persuasiveness of public narratives. Journal of Personality and Social Psychology79(5): 701–721.
18.
GreenMCFitzgeraldK (2017) Transportation theory applied to health and risk messaging. Oxford Research Encyclopedia of Communication. DOI: 10.1093/acrefore/9780190228613.013.261.
19.
HeijndersMVan Der MeijS (2006) The fight against stigma: An overview of stigma-reduction strategies and interventions. Psychology, Health & Medicine11(3): 353–363.
20.
HerekGMCapitanioJP (1993) Public reactions to AIDS in the United States: A second decade of stigma. American Journal of Public Health83(4): 574–577.
21.
HerekGMCapitanioJPWidamanKF (2002) HIV-related stigma and knowledge in the United States: Prevalence and trends, 1991–1999. American Journal of Public Health92(3): 371–377.
22.
HernandezISharmaVReina-OrtizM, et al. (2020) HIV/AIDS-related knowledge and behavior among school-attending Afro-descendant youths in Ecuador. International Journal of MCH and AIDS9(3): 397–407.
23.
IBM Corp. (n.d.) IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.
JonesCJSmithHLlewellynC (2014) Evaluating the effectiveness of health belief model interventions in improving adherence: A systematic review. Health Psychology Review8(3): 253–269.
27.
KaneJCElafrosMAMurraySM, et al. (2019) A scoping review of health-related stigma outcomes for high-burden diseases in low- and middle-income countries. BMC Medicine17: 17.
28.
KingoriCHaileZTNgatiaP, et al. (2017) Factors that can influence feelings towards and interactions with people living with HIV/AIDS in rural Central Kenya. International Journal of STD & AIDS28(9): 910–919.
29.
KingoriCReeceMObengS, et al. (2012) Impact of internalized stigma on HIV prevention behaviors among HIV-infected individuals seeking HIV care in Kenya. AIDS Patient Care and STDs26(12): 761–768.
30.
KinslerJJWongMDSaylesJN, et al. (2007) The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care and STDs21(8): 584–592.
31.
LeeRSKochmanASikkemaKJ (2002) Internalized stigma among people living with HIV-AIDS. AIDS and Behavior6(4): 309–319.
32.
LuzPMVelosoVGGrinsztejnB (2019) The HIV epidemic in Latin America: Accomplishments and challenges on treatment and prevention. Current Opinion in HIV and AIDS14(5): 366–373.
33.
MachowskaABamboriaBLBercanC, et al. (2020) Impact of ‘HIV-related stigma-reduction workshops’ on knowledge and attitude of healthcare providers and students in Central India: A pre-test and post-test intervention study. BMJ Open10(4): e033612.
34.
McQueenAKreuterMWKalesanB, et al. (2011) Understanding narrative effects: The impact of breast cancer survivor stories on message processing, attitudes, and beliefs among African American women. Health Psychology: Official Journal of the Division of Health Psychology, American Psychological Association30(6): 674–682.
35.
Mahajan AnishPSaylesJNPatelVA, et al. (2008) Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS (London, England)22(Suppl. 2): S67–S79.
MurphySTFrankLBChatterjeeJS, et al. (2013) Narrative versus nonnarrative: The role of identification, transportation, and emotion in reducing health disparities. Journal of Communication63(1): 116–137.
39.
NachegaJBMorroniCZunigaJM, et al. (2012) HIV-related stigma, isolation, discrimination, and serostatus disclosure: A global survey of 2035 HIV-infected adults. Journal of the International Association of Physicians in AIDS Care11(3): 172–178.
40.
PaudelVBaralKP (2015) Women living with HIV/AIDS (WLHA), battling stigma, discrimination and denial and the role of support groups as a coping strategy: A review of literature. Reproductive Health12: 53.
41.
PulerwitzJMichaelisAWeissE, et al. (2010) Reducing HIV-related stigma: Lessons learned from horizons research and programs. Public Health Reports125(2): 272–281.
42.
RaoDFeldmanBJFredericksenRJ, et al. (2012) A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS and Behavior16(3): 711–716.
43.
RoodBAReisnerSLSuraceFI, et al. (2016) Expecting rejection: Understanding the minority stress experiences of transgender and gender-nonconforming individuals. Transgender Health1(1): 151–164.
44.
RosenstockIM (1974) Historical origins of the Health Belief Model: Health Education Monographs. Health Education & Behavior2: 328–335.
45.
RuedaSMitraSChenS, et al. (2016) Examining the associations between HIV-related stigma and health outcomes in people living with HIV/AIDS: A series of meta-analyses. BMJ Open6(7): e011453.
46.
SenguptaSBanksBJonasD, et al. (2011) HIV interventions to reduce HIV/AIDS stigma: A systematic review. AIDS and Behavior15(6): 1075–1087.
47.
StanglALLloydJKBradyLM, et al. (2013) A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: How far have we come?Journal of the International AIDS Society16(3Suppl. 2): 18734.
48.
Tal-OrN (2016) How co-viewing affects attitudes: The mediating roles of transportation and identification. Media Psychology19(3): 381–405.
49.
UNAIDS (2020) Ecuador fact sheet – Ecuador 2020 HIV and AIDS Estimates. AIDSinfo UNAIDS. Available at: https://aidsinfo.unaids.org/ (accessed 4 April 2022).
50.
WarikiWMNomuraSOtaE, et al. (2013) Interventions for reduction of stigma in people with HIV/AIDS. Cochrane Database of Systematic Reviews. DOI: 10.1002/14651858.CD006735.pub2.
51.
WuSLiLWuZ, et al. (2008) A brief HIV stigma reduction intervention for service providers in China. AIDS Patient Care and STDs22(6): 513–520.
