Reducing HIV Stigma for African American Women - Full Text View

Purpose

African American women account for 66% of HIV infections in women in the U.S., AIDS is a leading cause of death for African American women, and African Americans have the lowest medication adherence rates compared to other groups in the U.S. One of the reasons for low medication adherence among African Americans is fear of stigma. HIV stigma has been linked to depression, psychological distress, poor quality of life, poor medication adherence and service utilization contributing to morbidity and mortality. Research has found that stigma is a moderator to poor adherence via depressive symptoms.

The current study is a randomized control trial with a time and attention control group to test the effectiveness of a stigma reduction intervention adapted for use with African American women. A total of 224 African American women will be recruited to participate in the study. Half of the women will be from Chicago, Illinois (112) and the other half will be from Birmingham, Alabama (112). A workshop will be held once a study site has recruited 28 women, half of the women will be in the intervention group (14) and the other half will be in the control group (14). Each study site will have 4 cohorts of 28 women.

The main aims of the current study are:

to determine the long-term effectiveness of the intervention to reduce stigma for African American women living with HIV in Chicago Illinois and Birmingham, Alabama
to examine whether stigma reduction due to the intervention is associated with improved physical health biomarkers (CD4+ T cell count, viral load), mediated by reduced psychological symptoms (depressive symptoms), improved engagement to care, and improved medication adherence
to explore whether stigma reduction due to the intervention is moderated by location (Chicago vs. Birmingham), transmission risk factor, time since diagnosis, and perceived social support

We expect that the multimedia workshop intervention will demonstrate effectiveness in reducing internalized stigma through an easily-disseminated method, and that it will have a positive impact on medication adherence and engagement in care for African American women living with HIV.

Condition	Intervention
HIV	Behavioral: Unity Workshop Behavioral: Breast Cancer Screening


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Supportive Care
Official Title:	Reducing HIV Stigma to Improve Health Outcomes for African-American Women

Resource links provided by NLM:

MedlinePlus related topics: African American Health HIV/AIDS

U.S. FDA Resources

Further study details as provided by University of Washington:

Primary Outcome Measures:

Change in stigma scores from baseline to 12 months. [ Time Frame: baseline, after intervervention, 4 months, 6 months, 8 months, 12 months ] [ Designated as safety issue: No ]
We will see if the intervention/workshop reduces HIV related stigma after 1 year in the study. We will use the Stigma Scale for Chronic Illness to measure stigma.

Secondary Outcome Measures:

Location as a moderator variable [ Time Frame: baseline, after intervervention, 4 months, 6 months, 8 months, 12 months ] [ Designated as safety issue: No ]
This is a multi-site study (Chicago and Birmingham) and we are interested in seeing if location is a moderating variable
Post-Traumatic Stress Disorder Checklist [ Time Frame: baseline, 12 months ] [ Designated as safety issue: No ]
Adherence to HIV Medication [ Time Frame: baseline, after intervention, 4 months, 6 months, 8 months, 12 months ] [ Designated as safety issue: No ]
Adherence to HIV medication will be measured by participants self report of adherence using commonly used set of questions.
Patient Health Questionnaire (PHQ-9) [ Time Frame: baseline, after intervention, 4 months, 6 months, 8 months, 12 months ] [ Designated as safety issue: No ]
We will look at the correlation between stigma scores and depression scores over time.
Medical Outcomes Study Social Support Scale [ Time Frame: Study duration ] [ Designated as safety issue: No ]
We are going to use a validated social support scale, and analyze social support as a correlate.
substance abuse [ Time Frame: baseline, 12 months ] [ Designated as safety issue: No ]
substance use and stigma of substance use will be measured using: Alcohol Use disorders Identification Test (AUDIT) Severity of Dependence Scale (SDS) Substance Abuse Self Stigma (SASS)
Engagement in Care (from patient record) [ Time Frame: baseline, 4 months, 8 months, 12 months ] [ Designated as safety issue: No ]
Research assistants will access participants' medical records to see if patients have missed any HIV related visits (i.e. medical, counseling). Engagement to care will be measured as a proportion (missed visits over total scheduled). Rescheduled visits will not count as missed visits. At baseline, we will look at visits for the past 12 months.
HIV viral load (from medical chart) over 1 year study duration [ Time Frame: baseline, 4 months, 8 months, 12 months ] [ Designated as safety issue: No ]
We want to examine whether stigma reduction due to the intervention is associated with improved physical health bio-markers such as suppression in HIV viral load in the blood (taken from medical chart/previous clinical blood tests).
Change in CD4 count [ Time Frame: baseline, 4 months, 8 months, 12 months ] [ Designated as safety issue: No ]
We want to see wither stigma reduction from the intervention associated with improved physical health bio-markers such as CD4+ T cell count.


Estimated Enrollment:	224
Study Start Date:	June 2013
Estimated Study Completion Date:	December 2016
Estimated Primary Completion Date:	December 2016 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
Experimental: Unity Workshop The intervention is a workshop facilitated by a peer advocate (an African American woman who is also HIV positive) and a social worker. It has exercises, videos and group discussions intended to equip participants with coping skills to overcome HIV related stigma and the negative outcomes related to stigma. The workshop will last about 8 hours total across 2 two days (4 hours per day). The researcher in the current study has done a lot of work in adapting this intervention for African American women. The workshop has been piloted in Seattle and had promising results. Based on results in the pilot study, a 2 hour booster session has been added 6 months after the initial workshop	Behavioral: Unity Workshop The intervention is based on other stigma reduction programs that are being used internationally (HIV Stigma Toolkit developed by the International Center for Research on Women and trigger videos developed by International Training & Education Center for health).
Breast Cancer Screening The time and attention control group workshop will be facilitated by a research coordinator. The control group program is based on another program that is designed explore issues related to breast cancer screening among African American women. The program has the same format as the Unity Workshop, with video and group discussion. Although breast cancer may be associated with stigma, we anticipated that breast cancer stigmas would not be related to HIV-associated stigma, which is our primary outcome of interest. The control groups will be held during the same week as the Unity Workshops, and control group participants will complete assessments on the same schedule as the Unity Workshop participants.	Behavioral: Breast Cancer Screening

Arms

Assigned Interventions

Experimental: Unity Workshop

The intervention is a workshop facilitated by a peer advocate (an African American woman who is also HIV positive) and a social worker. It has exercises, videos and group discussions intended to equip participants with coping skills to overcome HIV related stigma and the negative outcomes related to stigma. The workshop will last about 8 hours total across 2 two days (4 hours per day). The researcher in the current study has done a lot of work in adapting this intervention for African American women. The workshop has been piloted in Seattle and had promising results. Based on results in the pilot study, a 2 hour booster session has been added 6 months after the initial workshop

Behavioral: Unity Workshop

The intervention is based on other stigma reduction programs that are being used internationally (HIV Stigma Toolkit developed by the International Center for Research on Women and trigger videos developed by International Training & Education Center for health).

Breast Cancer Screening

The time and attention control group workshop will be facilitated by a research coordinator. The control group program is based on another program that is designed explore issues related to breast cancer screening among African American women. The program has the same format as the Unity Workshop, with video and group discussion. Although breast cancer may be associated with stigma, we anticipated that breast cancer stigmas would not be related to HIV-associated stigma, which is our primary outcome of interest. The control groups will be held during the same week as the Unity Workshops, and control group participants will complete assessments on the same schedule as the Unity Workshop participants.

Behavioral: Breast Cancer Screening

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Genders Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

they are women who identify as having an African American racial/ethnic background
born in the U.S. (including women of Caribbean origin if born in the U.S.
speak and understand English as their primary language of communication outside the home
they are 18 years of age or older
have a documented HIV positive status (women are on antiretroviral treatment and women who are not on antiretroviral are eligible)
able to see and interact with a touchscreen computer in English.

Exclusion Criteria:

women who not self-identify as African American
women who are African born or born outside the United States
younger than 18 years of age
unable to provide informed consent
life expectancy less than 1 year per physician report
unable to see and interact with a touchscreen computer in English.

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01893112

Locations


United States, Alabama
University of Alabama Birmingham
Birmingham, Alabama, United States, 35233
United States, Illinois
Northwestern University (NU)
Chicago, Illinois, United States, 60611

Sponsors and Collaborators

University of Washington

University of Alabama at Birmingham

Northwestern University

Investigators


Principal Investigator:	Deepa Rao, PhD, MA	University of Washington

More Information

Publications:

CDC. HIV/AIDS Surveillance Report: Cases of HIV infection and AIDS in the United States. 2004.

CDC. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. Leading Cause of Death for Black Women 1999-2007. 2008; www.cdc.gov/ncipc/wisqars. Accessed December 4, 2011.

Halkitis PN, Parsons JT, Wolitski RJ, Remien RH. Characteristics of HIV antiretroviral treatments, access and adherence in an ethnically diverse sample of men who have sex with men. AIDS Care. 2003 Feb;15(1):89-102.

Palacio H, Kahn JG, Richards TA, Morin SF. Effect of race and/or ethnicity in use of antiretrovirals and prophylaxis for opportunistic infection: a review of the literature. Public Health Rep. 2002 May-Jun;117(3):233-51; discussion 231-2. Review.

Traeger L, O'Cleirigh C, Skeer MR, Mayer KH, Safren SA. Risk factors for missed HIV primary care visits among men who have sex with men. J Behav Med. 2012 Oct;35(5):548-56. doi: 10.1007/s10865-011-9383-z. Epub 2011 Nov 9.

Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care. 2007 Jan;19(1):28-33.

Rintamaki LS, Davis TC, Skripkauskas S, Bennett CL, Wolf MS. Social stigma concerns and HIV medication adherence. AIDS Patient Care STDS. 2006 May;20(5):359-68.

Rao D, Feldman BJ, Fredericksen RJ, Crane PK, Simoni JM, Kitahata MM, Crane HM. A structural equation model of HIV-related stigma, depressive symptoms, and medication adherence. AIDS Behav. 2012 Apr;16(3):711-6. doi: 10.1007/s10461-011-9915-0.

Rao D, Desmond M, Andrasik M, Rasberry T, Lambert N, Cohn SE, Simoni J. Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV. AIDS Patient Care STDS. 2012 Oct;26(10):614-20. doi: 10.1089/apc.2012.0106. Epub 2012 Sep 17.


Responsible Party:	Deepa Rao, Assistant Professor, University of Washington
ClinicalTrials.gov Identifier:	NCT01893112 History of Changes
Other Study ID Numbers:	R01MH098675
Study First Received:	February 11, 2013
Last Updated:	May 10, 2016
Health Authority:	United States: Data and Safety Monitoring Board

ClinicalTrials.gov processed this record on September 30, 2016