Assessing the Impact of Food Assistance on Stigma Among People Living with HIV in Uganda Using the HIV/AIDS Stigma Instrument-PLWA (HASI-P)
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HIV-related stigma among persons living with HIV/AIDS (PLHIV) is prevalent throughout sub-Saharan Africa. There is limited evidence, however, on which interventions are effective in reducing it. We used data from a prospective impact evaluation of a 12-month food assistance intervention among 904 antiretroviral therapy (ART)- naïve PLHIV in Uganda to examine the program impact on stigma. Stigma was measured using the comprehensive HASI-P scale, which demonstrated good internal consistency (Cronbach’s alpha = 0.87) and was correlated with several related constructs including physical and mental health-related quality of life, disclosure, and physical health symptoms in the sample. Using quasi-experimental difference-in-difference matching methods to better infer causality, we tested whether the intervention improved the overall stigma scale and its subscales. The food assistance intervention had a significant effect on reported internalized (but not external) stigma of approximately 0.2 SD (p < 0.01). The HASI-P stigma scale is a useful tool for measuring and tracking stigma. Food assistance interventions, embedded in an HIV care program, can reduce internalized stigma.
KeywordsHIV infection Stigma Food assistance Food security Uganda
List of Abbreviations
Health-related quality of life
Household food insecurity access scale
Mental health summary score
Medical outcomes study HIV health survey
People living with HIV/AIDS
Physical health summary score
The AIDS support organization
World food programme
The authors gratefully acknowledge the support of TASO staff, particularly those at the Gulu and Soroti centers, as well as the field team and field supervisor, Moses Odeke. Robert Ochai and Frances Babirye at TASO headquarters provided tremendous support to the overall study. We thank WFP in Uganda for its support and an anonymous referee for valuable comments. Lastly, we thank all of the TASO clients for their participation.
Conceived and designed the experiments: SK, RR. Analyzed the data: JM, FW, RBR. All interpreted the statistical analysis and wrote the manuscript.
Compliance with ethical standards
Conflict of interest
The authors declare no conflict of interest.
This data collection for this study was funded by the International Initiative for Impact Evaluation (3ie), Concern Worldwide, and the Regional Network on AIDS, Livelihoods, and Food Security (RENEWAL), facilitated by IFPRI. RENEWAL is grateful for support from Irish Aid and the Swedish International Development Cooperation Agency (SIDA). The funding bodies had no role in the study design, data collection, analysis, interpretation, or manuscript preparation.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The ethics review boards of TASO and the International Food Policy Research Institute approved the study protocol, and the study received clearance from the Uganda National Council on Science and Technology.
Informed consent was obtained from all individual participants included in the study.
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