A pilot pragmatic trial of a "what matters most"-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana

Lawrence H Yang; Evan L Eschliman; Haitisha Mehta; Supriya Misra; Ohemaa B Poku; Patlo Entaile; Timothy D Becker; Tadele Melese; Merrian J Brooks; Marlene Eisenberg; Melissa A Stockton; Karen Choe; Danielle Tal; Tingyu Li; Vivian F Go; Bruce G Link; Shathani Rampa; Valerie W Jackson; Gorata D Manyeagae; Tonya Arscott-Mills; Melody Goodman; Philip R Opondo; Ari R Ho-Foster; Michael B Blank

doi:10.1186/s12981-022-00454-3

A pilot pragmatic trial of a "what matters most"-based intervention targeting intersectional stigma related to being pregnant and living with HIV in Botswana

AIDS Res Ther. 2022 Jun 23;19(1):26. doi: 10.1186/s12981-022-00454-3.

Authors

Lawrence H Yang^#^{1

2}, Evan L Eschliman^#³, Haitisha Mehta⁴, Supriya Misra⁵, Ohemaa B Poku⁶, Patlo Entaile⁷, Timothy D Becker⁸, Tadele Melese⁹, Merrian J Brooks^{7

10

11

12}, Marlene Eisenberg¹¹, Melissa A Stockton¹³, Karen Choe⁴, Danielle Tal⁴, Tingyu Li⁴, Vivian F Go¹⁴, Bruce G Link^{15

16}, Shathani Rampa¹⁷, Valerie W Jackson¹⁸, Gorata D Manyeagae¹⁹, Tonya Arscott-Mills^{12

20}, Melody Goodman²¹, Philip R Opondo²², Ari R Ho-Foster^{20

23}, Michael B Blank¹¹

Affiliations

¹ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, USA. ly1067@nyu.edu.
² Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA. ly1067@nyu.edu.
³ Department of Health, Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA.
⁴ Department of Clinical and Counseling Psychology, Teachers College, Columbia University, New York, NY, USA.
⁵ Department of Public Health, San Francisco State University, San Francisco, CA, USA.
⁶ Division of Gender, Sexuality, and Health, HIV Center for Clinical and Behavioral Studies, Columbia University and New York State Psychiatric Institute, New York, NY, USA.
⁷ Botswana-UPenn Partnership, Gaborone, Botswana.
⁸ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁹ Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
¹⁰ Department of Pediatrics, Craig Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
¹¹ Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
¹² Department of Pediatrics and Adolescent Health, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
¹³ Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons & New York State Psychiatric Institute, New York, USA.
¹⁴ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.
¹⁵ School of Public Policy, University of California Riverside, Riverside, CA, USA.
¹⁶ Department of Sociology, University of California Riverside, Riverside, CA, USA.
¹⁷ Department of Psychology, University of Botswana, Gaborone, Botswana.
¹⁸ Department of Anesthesia, University of California San Francisco, San Francisco, CA, USA.
¹⁹ Department of Statistics, Faculty of Social Sciences, University of Botswana, Gaborone, Botswana.
²⁰ Center for Global Health, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
²¹ Department of Biostatistics, School of Global Public Health, New York University, New York, NY, USA.
²² Department of Psychiatry, Faculty of Medicine, University of Botswana, Gaborone, Botswana.
²³ Office of Research and Graduate Studies, Faculty of Medicine, University of Botswana, Gaborone, Botswana.

^# Contributed equally.

Abstract

We conducted a pilot trial of an intervention targeting intersectional stigma related to being pregnant and living with HIV while promoting capabilities for achieving 'respected motherhood' ('what matters most') in Botswana. A pragmatic design allocated participants to the intervention (N = 44) group and the treatment-as-usual (N = 15) group. An intent-to-treat, difference-in-difference analysis found the intervention group had significant decreases in HIV stigma (d = - 1.20; 95% CI - 1.99, - 0.39) and depressive symptoms (d = - 1.96; 95% CI - 2.89, - 1.02) from baseline to 4-months postpartum. Some, albeit less pronounced, changes in intersectional stigma were observed, suggesting the importance of structural-level intervention components to reduce intersectional stigma.

Keywords: Botswana; Culture; Intersectional stigma; Pregnant women living with HIV; Stigma intervention.

Publication types

Pragmatic Clinical Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Botswana / epidemiology
Female
HIV Infections* / epidemiology
HIV Infections* / therapy
Humans
Pilot Projects
Pregnancy
Social Stigma

Abstract

Publication types

MeSH terms

Grants and funding