An agricultural livelihood intervention is associated with reduced HIV stigma among people living with HIV.

Journal: AIDS (London, England)

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Affiliated Institutions:  Department of Medicine, University of California, San Francisco, Potrero Avenue, SFGH , San Francisco, CA, , USA. Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box Off Raila Odinga Way, Nairobi, Kenya. Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, Discovery I, Greene Street, University of South Carolina, Columbia, South Carolina, , USA. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, th Street, San Francisco, CA, , USA. Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Guardian Drive, Blockley Hall, Philadelphia, PA, -, USA. School of Nursing and Health Studies, University of Washington Bothell, Campus Way NE, Bothell, WA, , USA. Center for Global Health and Mongan Institute, Massachusetts General Hospital, Fruit Street, Boston, MA, , USA. Department of Epidemiology and Biostatistics, University of California, San Francisco, California Street, San Francisco, CA, , USA Title Page. Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Hillside Road, Storrs, CT, -, USA.

Abstract summary 

HIV stigma undermines antiretroviral treatment (ART) adherence and viral suppression. Livelihood interventions may target drivers of negative attitudes towards people living with HIV (PLHIV) by improving their health and strengthening their economic contributions. We examined the effects of a multisectoral agricultural livelihood intervention on HIV stigma among PLHIV in western Kenya.Sixteen health facilities were randomly allocated (1:1) to intervention or control arms in Shamba Maisha, a cluster randomized controlled trial that aimed to improve HIV-related health through behavioral, mental health, and nutritional pathways.The intervention included a farming loan and agricultural and financial training. Participants had access to farmland and surface water and were ≥18 years old, on ART >six months, and moderately-to-severely food insecure. We measured internalized, anticipated, and enacted HIV stigma semiannually over two years using validated scales. In blinded intent-to-treat analyses, we compared changes in scores over 24 months, by study arm, using longitudinal multi-level difference-in-differences linear regression models that accounted for clustering.Of 720 enrolled participants (354 intervention), 55% were female, and the median age was 40 years (interquartile range 34-47 years). Two-year retention was 94%. Compared to the control arm, the intervention resulted in significant decreases (p < 0.001) of 0.42 points (95% confidence interval (CI) -0.52, -0.31) in internalized stigma, 0.43 points (95% CI -0.51, -0.34) in anticipated stigma, and 0.13 points (95% CI -0.16, -0.09) in enacted stigma over 24 months.The agricultural livelihood intervention reduced HIV stigma among PLHIV. Poverty-reduction approaches may be a novel strategy for reducing HIV stigma.

Authors & Co-authors:  Weiser Sheri D SD Sheira Lila A LA Weke Elly E Zakaras Jennifer M JM Wekesa Pauline P Frongillo Edward A EA Burger Rachel L RL Mocello Adrienne Rain AR Thirumurthy Harsha H Dworkin Shari L SL Tsai Alexander C AC Kahn James G JG Butler Lisa L Bukusi Elizabeth A EA Cohen Craig R CR

Study Outcome 

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Citations : 
Authors :  15
Identifiers
Doi : 10.1097/QAD.0000000000003928
SSN : 1473-5571
Study Population
Male,Female
Mesh Terms
Other Terms
Study Design
Study Approach
Country of Study
Kenya
Publication Country
England