Experiences of Stigma and Support Reported by Participants in a Network Intervention to Reduce HIV Transmission in Athens, Greece; Odessa, Ukraine; and Chicago, Illinois
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.
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.
This study was funded by the National Institute on Drug Abuse (DP1DA034989; PI Dr. Samuel R. Friedman).
Compliance with Ethical Standards
Conflict of interest
None of the authors have any conflicts of interest to declare.
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 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.
- 3.Marzel A, Shilaih M, Yang WL, Böni J, Yerly S, Klimkait T, et al. HIV-1 transmission during recent infection and during treatment interruptions as major drivers of new infections in the Swiss HIV Cohort Study. Clin Infect Dis. 2016;62(1):115–22. https://doi.org/10.1093/cid/civ732.CrossRefGoogle Scholar
- 5.UNAIDS. 90–90–90: An ambitious treatment target to help end the AIDS epidemic. Joint United Nations Programme on HIV/AIDS (UNAIDS): UNAIDS/JC2684. 2014. http://www.unaids.org/sites/default/files/media_asset/90-90-90_en.pdf.
- 10.Nikolopoulos GK, Pavlitina E, Muth SQ, Schneider J, Psichogiou M, Williams LD, Paraskevis D, Sypsa V, Magiorkinis G, Smyrnov P, Korobchuk A, Vasylyeva T, Skaathun B, Malliori M, Kafetzopoulos E, Hatzakis A, Friedman SR. A network intervention that locates and intervenes with recently HIV-infected persons: the Transmission Reduction Intervention Project (TRIP). Sci Rep. 2016;6:38100. https://doi.org/10.1038/srep38100.CrossRefGoogle Scholar
- 12.Williams LD, Korobchuk A, Smyrnov P, Sazonova Y, Nikolopoulos G, Skaathun B, Morgan E, Schneider J, Vasylyeva TI, Duong YT, Chernyavska S, Goncharov V, Kotlik L, Friedman SR. Social network approaches to locating people recently infected with HIV in Odessa, Ukraine. Manuscript submitted to J Int AIDS Soc. (unpublished manuscript).Google Scholar
- 20.Passin WF, Kim AS, Hutchinson AB, Crepaz N, Herbst JH, Lyles CM, HIV/AIDS Prevention Research Synthesis Project Team. A systematic review of HIV partner counseling and referral services: client and provider attitudes, preferences, practices, and experiences. Sex Transm Dis. 2006;33(5):320–8.Google Scholar
- 21.Hickey MD, Salmen CR, Omollo D, Mattah B, Fiorella KJ, Geng EH, Bacchetti P, Blat C, Ouma GB, Zoughbie D, Tessler RA, Salmen MR, Campbell H, Gandhi M, Shade S, Njoroge B, Bukusi EA, Cohen CR. Implementation and operational research: pulling the network together: quasiexperimental trial of a patient-defined support network intervention for promoting engagement in HIV care and medication adherence on Mfangano Island, Kenya. J Acquir Immune Defic Syndr (JAIDS). 2015;69(4):e127–34.CrossRefGoogle Scholar
- 24.Duong YT, Qiu M, De AK, Jackson K, Dobbs T, Kim AA, Nkengasong JN, Parekh BS. Detection of recent HIV-1 infection using a new limiting-antigen avidity assay: potential for HIV-1 incidence estimates and avidity maturation studies. PLoS ONE. 2012;7:e33328. https://doi.org/10.1371/journal.pone.0033328.CrossRefGoogle Scholar
- 27.Williams LD, Aber JL, SIZE Research Group. HIV/AIDS-related stigma, health service barriers, and HIV outcomes in South Africa: using a multilevel framework to test empirical relationships. Manuscript submitted to AIDS and Behavior (in press).Google Scholar
- 32.Westbrook L, Bauman L. Perceived stigma of HIV/AIDS: public view. Bronx: Albert Einstein College of Medicine; 1996.Google Scholar
- 33.Psichogiou M, Giallouros G, Pantavou K, Pavlitina E, Papadopoulou M, Williams LD, et al. Identifying, linking, and treating people who inject drugs and were recently infected with HIV. Manuscript submitted to AIDS Care (unpublished manuscript).Google Scholar