Developing and evaluating a community-based HIV/AIDS stigma reduction intervention in Ongenga constituency of Ohangwena Region, Namibia.

Abstract

Background: Namibia has been affected by the HIV/AIDS pandemic with infected and affected persons experience stigma at different levels. As there were no local stigma reduction intervention tools, this study aimed to develop, implement and evaluate tools at different levels in a rural Namibian community. Methods: An intervention research with a quasi-experimental non-equivalent control group pre-and post-test sample plan was used, with both qualitative and quantitative approaches. Four groups of participants participated: People Living with HIV/AIDS (PLWHA), their family members, community leaders and health care workers (n=224). The LINMODEL community participation and Frohlich Model informed the participant selection, and the Diffusion of Innovations theory provided the framework for justifying the use of targeted intervention tools in specific groups. Seven communities and a clinic were divided into the control (n=107) and intervention (n=117) arms. The study consisted of pre- and post-intervention questionnaires for both arms, intervention training workshops for the PLWHA and community leaders, and in-depth interviews for the community and opinion leaders. The post-intervention results showed that stigma decreased significantly in social isolation (p=0.017), workplace stigma (p=0.008) and negative self perception (p=0.006) in the PLWHA intervention arm. Verbal abuse (p=0.07) has slightly decreased but there was no statistically significant difference between the two study arms. Fear of contagion (p=0.12) has slightly increased after intervention in both arms. All mean scores (PLWHA) for the control arm increased significantly after the intervention. Regarding the family and vii community leaders results, only the household stigma score (p=0.01) decreased significantly in the intervention arm. Health care workers reported increased stigma after intervention, stigma against PLWHA (p=0.04) and associated stigma towards health care providers (p=0.005). Discussion: A comparison of the results in both arms indicated that the intervention was effective in reducing stigma in the intervention arm in three groups (group 4 excluded) with varying degrees of success. Stigma scores were significantly decreased in PLWHA from the intervention arm. The intervention was effective although it did not decrease all stigma scores significantly. This may require more time for the issues addressed in the intervention workshops to diffuse through the different groups.