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An Intervention to Reduce HIV-Related Stigma Among African American Communities in South Carolina

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An Intervention to Reduce HIV-Related Stigma Among African American Communities ... Bambi Gaddist, DrPH. South Carolina HIV/AIDS Council. Letitia Johnson-Arnold, MSPH ... – PowerPoint PPT presentation

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Title: An Intervention to Reduce HIV-Related Stigma Among African American Communities in South Carolina


1
An Intervention to Reduce HIV-Related Stigma
Among African American Communities in South
Carolina
Presentation at the 2005 National HIV Prevention
Conference
  • 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, 330-500 PM Session
NumberM3-C17-05, LocationEmbassy-Hong
Kong Funded by the Academy for Educational
Development
2
Outline of Todays Talk
  • Background - HIV in South Carolina
  • South Carolina HIV/AIDS Council
  • General Survey 2003-2004
  • Some comparisons of the General Survey to a
    national probability sample
  • A conceptual model of stigma
  • 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

3
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).

4
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

5
General Survey 2003-2004
  • 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

6
more avoidance
SCHAC survey items not in Herek survey
Bars in pink represent 95 confidence intervals
for national probability survey
7
Bars in pink represent 95 confidence intervals
for national probability survey
8
more misconceptions
Bars in pink represent 95 confidence intervals
for national probability survey
9
Bars in pink represent 95 confidence intervals
for national probability survey
10
Bars in pink represent 95 confidence intervals
for national probability survey
11
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

12
A conceptual model of HIV-related stigma
13
Conceptual Model of Psychological Reactions to
Stigma
Cognitive Responses
Approach/ Avoidance Behaviors
Emotional Reactions
14
Components of Stigma in General Survey
Cognitive
Affective
Behavioral
Blame
Avoidance of PLWHA
Comfort- PLWHA
Belief in Casual Contact
Negative Emotions- PLWHA
15
Hierarchical Multiple Regression
Predicting Avoidance Intentions
STUDY 1
Step 1
Step 2
Blame
Comfort- PLWHA
ß.26
Avoidance of PLWHA
ß-.43
ß.29
Belief in Casual Contact
Negative Emotions- PLWHA
ß.34
R2.25, F(2,367)59.65, plt.01
R2.49, Fchange(2,365)85.46, plt.01
plt.05
16
Hierarchical Multiple Regression
Predicting Avoidance Intentions
STUDY 1
Step 1
Step 2
Blame
Comfort- PLWHA
ß-.48
Avoidance of PLWHA
ß.04
ß.11
Belief in Casual Contact
Negative Emotions- PLWHA
ß.30
R2.48, F(2,367)166.76, plt.01
R2.49, Fchange(2,365)3.51, plt.01
plt.05
17
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

18
An intervention evaluation
19
Intervention
  • Play about HIV infection in African American
    families
  • Themes
  • Forgiveness
  • Family support
  • Tolerance
  • It could happen to you

20
Design of Intervention Evaluation
Survey
Play
Discussion
Recruitment From the African American Community
Delay
Play
Discussion
Survey
21
Constructs Measured in the Intervention Survey
  • Empathy for persons living with HIV/AIDS (PLWHA)
    (?.82)
  • Negative emotions for PLWHA (?.77)
  • Blame (?.50)
  • Beliefs in transmission via causal contact
    (?.82)
  • Avoidance tendencies regarding PLWHA (?.82)
  • Attitudes about being tested (?.89)
  • Motivation to control prejudice regarding PLWHA
    (?.79)
  • Superstitious contagion beliefs (??)
  • Attitudes toward MSM and WSW (?.87, ?.93)
  • Personal contact with MSM and WSW (??)
  • Positive religious beliefs regarding PLWHA
    (?.67)
  • Support for coercive social policies (?.80)

22
Summary of the Analyses from the Intervention
Survey
  • There were no statistically significant
    differences between the two intervention
    conditions across any of the constructs
  • Participants in intervention study were from
    Richland County (pop334,609)
  • 3/4 of General Survey sample were from counties
    with less than 100,000 population
  • Comparisons between measures common across the
    Intervention Survey and the General Survey
    revealed that participants in the intervention
    blamed PLWHAs less than people from counties less
    than 100,000 they also indicated weaker
    avoidance intentions than people from counties
    less than 100,000
  • Ironically, participants in the intervention
    displayed certain negative emotions more than all
    others from the General Survey

23
Examining the HIV-related stigmaconceptual
model
24
Components of Stigma in Intervention Survey
Cognitive
Affective
Behavioral
Blame
Avoidance of PLWHA
Empathy- PLWHA
Belief in Casual Contact
Negative Emotions- PLWHA
25
Hierarchical Multiple Regression
Predicting Avoidance Intentions
STUDY 2
Step 1
Step 2
Blame
Empathy- PLWHA
ß.22
Avoidance of PLWHA
ß-.23
ß.33
Belief in Casual Contact
Negative Emotions- PLWHA
ß.07
R2.06, F(2,72)2.16, P.12
R2.19, Fchange(2,70)5.85, plt.01
plt.05 plt.07
26
Hierarchical Multiple Regression
Predicting Avoidance Intentions
STUDY 2
Step 1
Step 2
Blame
Empathy- PLWHA
ß-.24
Avoidance of PLWHA
ß.05
ß-.01
Belief in Casual Contact
Negative Emotions- PLWHA
ß.35
R2.19, F(2,72)8.41, plt.01
R2.19, Fchange(2,70)lt1, NS
plt.05
27
Summary
  • Affective components were more strongly related
    to variance in avoidance intentions than
    cognitive components of stigma

28
Why should prevention researchers be concerned
with HIV-related stigma?
29
Hierarchical Multiple Regression
Predicting Attitudes toward HIV Testing
STUDY 2
Step 1
Step 2
Blame
Empathy- PLWHA
ß-.30
Attitude Toward HIV Testing
ß.38
ß.01
Belief in Casual Contact
Negative Emotions- PLWHA
ß.11
R2.09, F(2,77)3.34 Plt.05
R2.22, Fchange(2,75)6.21, plt.01
plt.05
30
Hierarchical Multiple Regression
Predicting Attitudes toward HIV Testing
STUDY 2
Step 1
Step 2
Blame
Empathy- PLWHA
ß.43
Attitude Toward HIV Testing
ß.-.19
ß.06
Belief in Casual Contact
Negative Emotions- PLWHA
ß-.04
R2.19, F(2,77)8.88, plt.01
R2.22, Fchange(2,75)1.47, NS
plt.05
31
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

32
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

33
Special thanks to the following people who helped
in data analyses for this project
  • Jamie Hughes
  • Leah Pryor

34
Correlation Matrix from Intervention Study
Correlations in yellow are statistically
significant, p lt .05
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