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Experiences of Stigma and Support Reported by Participants in a Network Intervention to Reduce HIV Transmission in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois

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Abstract

A growing body of evidence suggests that network-based interventions to reduce HIV transmission and/or improve HIV-related health outcomes have an important place in public health efforts to move towards 90–90–90 goals. However, the social processes involved in network-based recruitment may pose a risk to participants of increasing HIV-related stigma if network recruitment causes HIV status to be assumed, inferred, or disclosed. On the other hand, the social processes involved in network-based recruitment to HIV testing may also encourage HIV-related social support. Yet despite the relevance of these processes to both network-based interventions and to other more common interventions (e.g., partner services), there is a dearth of literature that directly examines them among participants of such interventions. Furthermore, both HIV-related stigma and social support may influence participants’ willingness and ability to recruit their network members to the study. This paper examines (1) the extent to which stigma and support were experienced by participants in the Transmission Reduction Intervention Project (TRIP), a risk network-tracing intervention aimed at locating recently HIV-infected and/or undiagnosed HIV-infected people and linking them to care in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois; and (2) whether stigma and support predicted participant engagement in the intervention. Overall, experiences of stigma were infrequent and experiences of support frequent, with significant variation between study sites. Experiences and perceptions of HIV-related stigma did not change significantly between baseline and six-month follow-up for the full TRIP sample, and significantly decreased during the course of the study at the Chicago site. Experiences of HIV-related support significantly increased among recently-HIV-infected participants at all sites, and among all participants at the Odessa site. Both stigma and support were found to predict participants’ recruitment of network members to the study at the Athens site, and to predict participants’ interviewer-rated enthusiasm for naming and recruiting their network members at both the Athens and Odessa sites. These findings suggest that network-based interventions like TRIP which aim to reduce HIV transmission likely do not increase stigma-related risks to participants, and may even encourage increased social support among network members. However, the present study is limited by its associational design and by some variation in implementation by study site. Future research should directly assess contextual differences to improve understanding of the implications of site-level variation in stigma and support for the implementation of network-based interventions, given the finding that these constructs predict participants’ recruitment of network members and engagement in the intervention, and thereby could limit network-based interventions’ abilities to reach those most in need of HIV testing and care.

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Notes

  1. Respondent-driven sampling is an approach that uses participant referrals and participant-driven recruitment with an aim of reaching a representative sample of a hidden population (e.g., a very high-risk group) that is otherwise not easy to sample. Social network-based and risk network-based sampling, on the other hand, aim to recruit all (realistically, as large a proportion as possible of) relevant members of participants’ social network or risk network in order to understand social and/or risk connections and patterns or to perform a public health intervention within them.

  2. Note that analyses of changes between baseline and follow-up for the present study reflect only associations, as data for the TRIP study are not experimental.

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Acknowledgements

Research reported in this presentation was supported by the National Institute On Drug Abuse of the National Institutes of Health under Award Number DP1 DA034989 Transmission Research Intervention Project. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Our NIDA Project Officer, Elizabeth Lambert, has been a great source of wise counsel and advice. We also acknowledge assistance from the hundreds of participants in this project and hope that it has improved their lives and health as well as those of people in their networks and communities.

Funding

This study was funded by the National Institute on Drug Abuse (DP1DA034989; PI Dr. Samuel R. Friedman).

Author information

Authors and Affiliations

  1. Institute for Infectious Disease Research, National Development and Research Institutes, 71 West 23rd Street, Fourth Floor, New York, NY, 10010, USA

    Leslie D. Williams, M. J. Downing Jr. & S. R. Friedman

  2. The Alliance for Public Health, Kiev, Ukraine

    A. Korobchuk & P. Smyrnov

  3. Transmission Reduction Intervention Project, Athens, Greece

    E. Pavlitina

  4. Medical School, University of Cyprus, Nicosia, Cyprus

    G. K. Nikolopoulos & A. Hadjikou

  5. University of California San Diego, San Diego, USA

    B. Skaathun

  6. Medical School, University of Chicago, Chicago, USA

    J. Schneider

  7. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece

    E.-G. Kostaki, D. Paraskevis & A. Hatzakis

  8. Department of Zoology, University of Oxford, Oxford, UK

    T. I. Vasylyeva

  9. First Department of Internal Medicine, Laiko General Hospital, National and Kapodistrian University of Athens, Athens, Greece

    M. Psichogiou

  10. Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, Chicago, IL, USA

    E. Morgan

  11. Department of Psychology, Lehman College, Bronx, NY, USA

    M. J. Downing Jr.

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  1. Leslie D. Williams
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  9. T. I. Vasylyeva
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  14. M. J. Downing Jr.
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  16. S. R. Friedman
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Corresponding author

Correspondence to Leslie D. Williams.

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Conflict of interest

None of the authors have any conflicts of interest to declare.

Ethical Approval

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. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained for all study participants. All consent and assent forms were reviewed and approved by all institutional review boards in New York, Chicago, Athens, and Odessa, as described above.

Research Involving Human Participants

Institutional review board at National Development and Research Institutes (NDRI) in New York, NY approved all study procedures. Additionally, the institutional review board at the University of Chicago in Chicago, Illinois approved all procedures for the Chicago study site; the Medical Ethics Committee at Gromashevsky Institute of Epidemiology and Infectious Diseases in Ukraine approved all procedures for the Odessa, Ukraine study site; and the institutional review board at the Hellenic Society for the Study of AIDS and Sexually Transmitted Diseases in Athens, Greece approved all study procedures for the Athens, Greece study site.

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Williams, L.D., Korobchuk, A., Pavlitina, E. et al. Experiences of Stigma and Support Reported by Participants in a Network Intervention to Reduce HIV Transmission in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois. AIDS Behav 23, 1210–1224 (2019). https://doi.org/10.1007/s10461-019-02402-1

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