aparna jain, mph 1 ratana nuankaew 2 pakprim oranop na ayuthaya 3 kerry richter, phd 4
DESCRIPTION
Success! Interventions that work to reduce HIV stigma & discrimination in communities: Results of an evaluation study in Thailand. Aparna Jain, MPH 1 Ratana Nuankaew 2 Pakprim Oranop na Ayuthaya 3 Kerry Richter, PhD 4 Anne Stangl , PhD 5. XIX International AIDS Conference - PowerPoint PPT PresentationTRANSCRIPT
Success! Interventions that work to reduce HIV stigma & discrimination in communities: Results of an evaluation study in Thailand
Aparna Jain, MPH1
Ratana Nuankaew2
Pakprim Oranop na Ayuthaya3
Kerry Richter, PhD4
Anne Stangl, PhD5
XIX International AIDS ConferenceJuly 25, 2012
1Johns Hopkins University; 2Population & Community Development Association (PDA); 3Pact Thailand; 4 Institute for Population and Social Research, Mahidol University; 5International Center for Research on Women
2
Outline
• Project Interventions• Study Design• Results• Conclusion
3
Project Intervention
4
Positive Partnership Project Phase II
Goal1. Increase quality of life of people living with
HIV/AIDS 2. Increase income levels of people living with HIV3. Reduce HIV stigma and discrimination in the
community
Two models4. PPP clubs (PPPC)5. Village development banks (VDB)
5
Community Level Stigma Activities
1. Monthly meetings on banking day2. HIV campaigns 3. IEC materials with key messages
– Posters– Banking slips– Radio dramas
4. Funfairs – HIV/AIDS activity days
Banking slips with HIV key messageFunfair
Poster
Banking Day at VDB
6
Project Sites & Duration
• 11 PPP Clubs– Urban sites: Bangkok, Chiang
Mai, and Chonburi– Rural sites: Chiang Rai,
Nakonrachasima, Khon Kaen
• 12 Village Development Banks– Rural sites: Chiang Rai,
Nakonrajasima, Khon Kaen
• April 2008–September 2010
7
Study Design
8
Community Dataset• Panel of 11 communities (6 PPPC & 5 VDBs)• Two cross-sectional surveys:
– Baseline survey (October 2008 – March 2009)– Endline survey (November 2010 – January 2011)
• Sampling frames of households• Systematic random sampling of households • All individuals 15 years or older interviewed in
each household
9
Stigma Measures Previously validated stigma measures :1. Fear-driven stigma
– Fear of HIV transmission2. Value-driven stigma
– Shame associated with having HIV
Scale development:• Principle component factor analysis at baseline, confirmed
at endline• Predicted regression scores• Standardized scale to have a mean of 50 and standard
deviation of 10, scores range from 0 to 100
10
Results
11
Respondent Characteristics• Respondent characteristics were similar at baseline & endline
15-29 30-39 40-49 50+0
5
10
15
20
25
30
35
40
BaselineEndline
Age
12
Correct HIV Knowledge Improved
Reducing sexual interactions can prevent HIV
Having sex with those who look clean cannot prevent HIV
Being infected with HIV is not different from being sick with AIDS
There are medicines that can inhibit HIV (ARTs)
Exposure to HIV positive indivdiual's skin canot transmit HIV
Exposure to sweat/saliva of HIV postive individual cannot transmit HIV
Sharing personal items (nail cutter) cannot transmit HIV
Not all babies get HIV from an HIV postive mother
0 25 50 75 100
49
53
23
77**
72**
50**
31**
26**
47
48
19
70
63
39
15
16
Baseline (n=560)Endline (n=560)
Percentage**p-value< 0.01; * p-value<0.05
13
Fear-Driven Stigma Reduced
Having a meal with an HIV positive individual (food sharing)
Taking care of an HIV positive individual
Carrying an HIV positive individual
Exposed to sweat of an HIV positive individual
Sharing cutlery items with an HIV positive individual
Exposed to saliva of an HIV positive individual
0 25 50 75 100
27*
35
38
34**
44**
56**
33
37
43
45
57
67
Baseline (n=560)Endline (n=560)
Percentage**p-value< 0.01; * p-value<0.05
14
Value-Driven Stigma (Shame) Reduced
I would feel ashamed if someone in my family had
HIV
People living with HIV should be ashamed of themselves
I would feel ashamed if I was infected with HIV
0 25 50 75 100
27*
43
56
40
47
65
Baseline (n=560)Endline (n=560)
Percentage**p-value< 0.01; * p-value<0.05
15
Percent Exposed to Interventions
Banking day meetings
Campaign
Funfair
At least
1 poster
At least
1 radio drama
At least
1 messa
ge on banking slip
01530456075
1127
18
62 65 59
16
Percent Exposed to Intervention
0
10
20
30
40
50
60
No exposure
Exposure 1
Exposure 2
Exposure 3 (Campaign/Funfair/IEC)Exposure 3 (other com-binations)
Exposure 4
Multivariate Linear Analysis
‡Adjusted for sex, marital status, age, education, residence, personal income, occupation, & media exposure to HIV messaging, baseline community average of fear
Fear-driven stigma β coef. (95% CI)Personally knew a person living with HIV no ref yes -2.59** -4.49 -0.69HIV/AIDS Knowledge 0-3 correct responses ref 4-9 correct responses -4.83** -6.48 -3.19Intervention exposures None or one ref Two -1.09 -3.10 0.91 Three (Campaign/Funfair/IEC) -3.81* -7.33 -0.29 Three (Other combinations) -2.67 -6.30 0.97 Four -0.79 -5.61 4.02Constant 52.93 46.68 59.18**p-value< 0.01; * p-value<0.05
Multivariate Linear Analysis Value-driven stigma (shame) β coef. (95% CI)Personally knew a person living with HIV no ref yes -1.94 -3.85 -0.03HIV/AIDS Knowledge 0-3 correct responses ref 4-9 correct responses -3.79** -5.46 -2.12Intervention exposures None or one Ref Two -0.72 -2.76 1.32
Three (Campaign/Funfair/IEC) -4.26* -7.82 -0.71 Three (Other combinations) -1.10 -4.79 2.58 Four -4.23 -9.11 0.66Constant 51.80 45.88 57.73
‡Adjusted for sex, marital status, age, education, residence, personal income, occupation, & media exposure to HIV messaging, baseline community average of shame
**p-value< 0.01; * p-value<0.05
19
Findings• Correct knowledge of HIV improved• Fear and shame reduced• Greater correct HIV knowledge is associated with
lower levels of fear and shame• Personally knowing someone living with HIV is
associated with lower levels of fear but not shame• A combination of interventions for shifting
community level fear and shame– HIV campaigns, Funfairs, IEC materials with key messages
20
Conclusions• Involving people living with HIV in every step
of the project• Important to tackle HIV stigma and
discrimination using a combination of approaches
• First step: increase correct HIV knowledge• Thailand HIV & AIDS Strategy 2012-2016
– To reduce HIV stigma and discrimination by half
21
Acknowledgements
• Arunee Bunpabut & Nungruthai Mongkolviboonpol, PDA Research and Evaluation Staff
• Urai Homtawee, Malee Sunsiri, & Ekachai Kumissara, PDA Program Staff
• Supol Singhapoom, PACT M&E Officer• Laura Nyblade, RTI International• Department of Population, Family & Reproductive Health, JHSPH• The Bill & Melinda Gates Institute of Population & Reproductive
Health, JHSPH