Effects of an intervention on internalized HIV-related stigma for individuals newly entering HIV care

Abstract

Objective: Considering the association between internalized HIV-related stigma and treatment adherence, an intervention addressing HIV treatment adherence may have the added benefit of reducing internalized stigma. The 'integrating ENGagement and Adherence Goals upon Entry' (iENGAGE) intervention was developed to facilitate adjustment to living with HIV among individuals newly engaged in HIV care. We evaluated the effects of this intervention on internalized stigma and examined whether the effect is moderated by depressive symptoms and coping styles.

Design: The iENGAGE intervention was tailored individually to improve information, motivation, and behavioral skills to promote treatment adherence and viral suppression. Three hundred and seventy-one participants initiating HIV care at four sites in the United States were randomly assigned to either the intervention receiving four face-to-face sessions or standard of care control arm.

Methods: Baseline and 48-week follow-up assessments were conducted, which included validated measures of internalized HIV-related stigma, depressive symptoms, and coping mechanisms (behavioral disengagement and self-blame) as secondary outcomes. A repeated measures ANOVA evaluated the effect of the intervention on change in internalized HIV stigma. Furthermore, the moderating effects of depressive symptoms and coping mechanisms on the decrease in internalized stigma were examined.

Results: The decrease in internalized stigma from baseline to 48 weeks was significantly larger in the intervention arm compared with the control arm. This effect was significantly moderated by baseline levels of depressive symptoms and self-blame.

Conclusion: The multifaceted iENGAGE intervention is effective in reducing internalized stigma for new-to-HIV care individuals, especially with higher depressive symptoms or when using higher levels of self-blame coping.

Trial registration: ClinicalTrials.gov NCT01900236.

Figures

Figure 1.. Participant flow diagram.

*93 of the 234 were not new to care participants; # There were 5 questions for participants to meet the inclusion criteria and participants could choose multiple reasons.

Figure 2.

Effect of study arm on in internalized HIV stigma. ***p < .001, ns = not significant.

Figure 3.

Interaction of depressive symptoms with study arm on decrease in internalized HIV stigma. **p < .01, ns = not significant. Note that “decrease in internalized HIV stigma” indicates difference between the baseline and follow-up levels in internalized HIV stigma.

Figure 4.

Interaction of self-blame with study arm on decrease in internalized HIV stigma. **p < .01, ns = not significant. Note that negative values for “decrease in internalized HIV stigma” indicate an “increase” as opposed to a “decrease” in internalized HIV stigma from baseline to follow-up.