, Volume 9, Issue 3, pp 871–883 | Cite as

The Application of Mindfulness for Individuals Living with HIV in South Africa: a Hybrid Effectiveness-Implementation Pilot Study

  • Tracy-Leigh McIntyre
  • Diane Elkonin
  • Margo de Kooker
  • Jessica F. MagidsonEmail author


Despite the recent growth of mindfulness research worldwide, there remains little research examining the application of mindfulness-based interventions in resource-limited, international settings. This study examined the application of Mindfulness-Based Stress Reduction (MBSR) for HIV-infected individuals in South Africa, where rates of HIV are highest in the world. Mixed methods were used to examine the following over a three-month follow-up: (1) feasibility, acceptability, and preliminary adaptation of MBSR for this new context; and (2) effects of MBSR on immune functioning, self-reported mindfulness (MAAS, FFMQ), depression, anxiety, and stress (DASS-21). Ten individuals initiated MBSR, and seven completed all eight sessions. Results indicated medium effect size improvements in immune functioning (CD4 count and T cell count; d = .5) through the three-month follow-up, though the small sample size limited power to detect a statistically significant effect. From baseline to post-treatment, improvements in “Observing” and “Non-reactivity” (FFMQ) approached statistical significance with large effect sizes (observing: d = 1.5; p = .08; non-reactivity: d = .7; p = .07). There were no statistically significant changes in depression, anxiety, or stress throughout the study period. Primary areas for adaptation of MBSR included emphasis on informal practice, ways to create “space” without much privacy, and ways to concretize the concepts and definitions of mindfulness. Feedback from participants can shape future adaptations to MBSR for this and similar populations. Findings provide preliminary evidence regarding the implementation of MBSR for individuals living with HIV in South Africa. A future randomized clinical trial with a larger sample size is warranted.


Mindfulness Mindfulness-based stress reduction (MBSR) Immune functioning HIV Global mental health 



We would like to acknowledge Alida Sandison and Danie Venter for their assistance and support conducting this study and the research participants for participating in the 8-week mindfulness course and the study. We would like to acknowledge Christopher Funes’ review and technical support for the manuscript.

Author Contributions

TLM designed and executed the study under the mentorship of DE, wrote the initial draft of the paper. DE supervised TLM on all aspects of study design and write up. MDK ran the MBSR groups, oversaw adaptation for the local context, and provided critical revisions to this manuscript. JFM oversaw manuscript preparation and collaborated with the other authors in the writing and editing of the final manuscript.

Funding Information

TLM and DE received support from Nelson Mandela Metropolitan University to conduct the research project. Dr. Magidson’s time on this manuscript was supported by the National Institutes of Health [K23DA041901]. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee, approved by the Nelson Mandela Metropolitan University Research Ethics Committee and the Nelson Mandela Bay Health District, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Conflict of Interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Tracy-Leigh McIntyre
    • 1
  • Diane Elkonin
    • 1
  • Margo de Kooker
    • 1
  • Jessica F. Magidson
    • 2
    Email author
  1. 1.Department of PsychologyNelson Mandela Metropolitan UniversityPort ElizabethSouth Africa
  2. 2.Department of PsychiatryMassachusetts General Hospital/Harvard Medical SchoolBostonUSA

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