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Pilot Outcomes of Maisha: An HIV Stigma Reduction Intervention Developed for Antenatal Care in Tanzania

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Abstract

HIV stigma is a persistent barrier to curbing the spread of HIV and improving quality of life for people living with HIV. We developed and pilot tested Maisha, an HIV stigma reduction intervention in antenatal care (ANC) with two objectives: 1) among individuals living with HIV, reduce internalized and anticipated HIV stigma, with subsequent improvements in HIV care engagement, and 2) among individuals who are HIV-seronegative, reduce HIV stigmatizing attitudes. We enrolled and baselined 1039 women and 492 male partners presenting to a first ANC appointment and randomized them to standard of care or the Maisha intervention. All women living with HIV (WLHIV) and a subset of HIV-negative participants completed a 3-month follow-up assessment. Participation in the three Maisha sessions was high (99.6%, 92.8%, 89.3%), and nearly all participants noted satisfaction with the intervention content (99.8%) and counselor (99.8%). Among 55 WLHIV, care engagement outcomes did not differ by condition. Among 293 HIV-negative participants, Maisha participants had significantly greater reductions in the moral judgment sub-scale of the stigma attitudes measure (p < .001), but not the social distancing subscale. The ANC setting, where women and their partners are routinely tested for HIV, is an ideal venue for addressing HIV stigma. The Maisha intervention was feasible and acceptable, and had an impact on HIV stigma attitudes. A full trial is needed to examine impacts on HIV outcomes; modifications to the intervention should be considered to reduce social alienation of PLWH.

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Acknowledgments

This study was funded grants from the Fogarty International Center (R21 TW 011053) and Duke Center for AIDS Research (P30 AI064518). We also acknowledge fellowship support received from the NIH Office of Behavioral and Social Science Research (OBSSR) and the Fogarty International Center (D43 TW009337). The team is grateful for the support of the Tanzanian Ministry of Health, our fantastic research staff (Hashim Mdetele, Ismail Amiri, Betina Licky, Eva Olomi, and Joseph Charles), and the personnel in the study clinic.

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Authors and Affiliations

  1. Department of Population Health Sciences, University of Utah, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    Melissa H. Watt

  2. Kilimanjaro Clinical Research Institute, Moshi, Tanzania

    Linda Minja, Haika Osaki, Godfrey A. Kisigo & Blandina T. Mmbaga

  3. Duke Global Health Institute, Duke University, Box 90519, Durham, NC, 27708, USA

    Melissa H. Watt, Brandon A. Knettel, Rimel N. Mwamba, Joao R. N. Vissoci, Saumya S. Sao & Blandina T. Mmbaga

  4. Kilimanjaro Christian Medical University College, Moshi, Tanzania

    James S. Ngocho

  5. Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK

    Jenny Renju

  6. Department of Epidemiology and Biostatistics, Kilimanjaro Christian Medical University College, Moshi, Tanzania

    Jenny Renju

  7. School of Nursing, Duke University, 307 Trent Dr, Durham, NC, 27710, USA

    Brandon A. Knettel

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  1. Melissa H. Watt
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Correspondence to Melissa H. Watt.

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Watt, M.H., Minja, L., Knettel, B.A. et al. Pilot Outcomes of Maisha: An HIV Stigma Reduction Intervention Developed for Antenatal Care in Tanzania. AIDS Behav 25, 1171–1184 (2021). https://doi.org/10.1007/s10461-020-03093-9

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