an intervention to reduce hiv-related stigma among african american communities in south carolina...
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An Intervention to Reduce HIV-Related Stigma Among
African American Communities in South
Carolina
John B. Pryor, Ph.D.
Department of Psychology
Illinois State University
Bambi Gaddist, DrPH
South Carolina HIV/AIDS Council
Letitia Johnson-Arnold, MSPH
South Carolina HIV/AIDS Council
6/13/2005, 3:30-5:00 PM
Session Number:M3-C17-05, Location:Embassy-Hong Kong
Funded by the Academy for Educational Development
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Presentation at thePresentation at the
2005 National HIV Prevention 2005 National HIV Prevention ConferenceConference
1. Background - HIV in South Carolina• South Carolina HIV/AIDS Council
2. General Survey 2003-2004• Some comparisons of the General Survey to a
national probability sample• A conceptual model of stigma
3. An Intervention Evaluation• No evidence for an immediate impact of the
intervention• Implications of intervention survey for factors
affecting stigma avoidance• Some connections between stigma and
prevention behavior
Outline of Today’s Talk
Background
• Approximately 201 of every 100,000 adults and adolescents in South Carolina are living with HIV and another 185 per 100,000 are living with AIDS (CDC, 2003).
• The number of AIDS cases among African Americans in South Carolina is higher than that among any other ethnic/racial group.
• The prevalence among Blacks is ten times that of Whites in South Carolina (CDC, 2004).
South Carolina HIV/AIDS Council
Three-prong initiative to reduce HIV-related stigma among African American communities throughout South Carolina:– Organizing educational town hall meetings in rural
communities– Developing and staging an educational theatre
production concerning HIV/AIDS stigma and discrimination
– A statewide media campaign
• Survey instrument was based upon national telephone surveys conducted by Herek and his colleagues in 1991, 1997, & 1999 (Herek, Capitanio, & Widaman, 2002)
• SCHAC General Survey sample was recruited from attendees at town hall meetings and theatrical performances organized by SCHAC
• Herek 1999 national probability sample: 669 adults
• SCHAC 2003-2004 sample: 403 African American adults in South Carolina
General Survey 2003-2004
Bars in pink represent 95% confidence intervals for national probability survey
Avoidant Intentions
8.5
9.1
29.3
20.1
56
22.7
25
19.4
26.9
0 10 20 30 40 50 60
Suppose you found out that the pastor of yourchurch had HIV/AIDS.
Suppose you found out that the pastor of yourchurch was homosexual.
Suppose you found out that a fellow Bible study orprayer partner had HIV/AIDS.
Suppose you had a young child who was attendingschool where one of the students was known to have
HIV/AIDS.
Suppose you worked in an office where someoneworking with you developed HIV/AIDS.
Suppose you found out that the owner of a smallneighborhood grocery store where you liked to shop
had HIV/AIDS.
percent who would avoid
CI-2.5% Herek Survey CI+2.5% SCHAC Survey
SC
HA
C s
urv
ey
item
s n
ot
in H
ere
k su
rve
y
more avoidance
Responsibility and Blame for HIV Infection
21.5
44.5
24.8
48.3
28.1
52.1
8
29
0 10 20 30 40 50 60
People who got HIV/AIDSthrough sex or drug use
have gotten what theydeserve.
Most people withHIV/AIDS are responsible
for having got theirillness.
Percent responding "agree' or "strongly agree"
CI-2.5% Herek Survey CI+2.5% SCHAC Survey
Bars in pink represent 95% confidence intervals for national probability survey
Bars in pink represent 95% confidence intervals for national probability survey
Misconceived HIV Transmission Beliefs
11.5
46.3
37.1
46.6
29.3
13.3
50.1
40.8
50.4
32.9
15.1
53.9
44.5
54.2
36.5
30.6
49.9
54.5
44.1
71.6
0 10 20 30 40 50 60 70 80
Kissing someone on thecheek that has HIV/AIDS.
Sharing a drink out of thesame glass with someone
who has HIV/AIDS.
Using public toilets
Being coughed on orsneezed on by someone
who has HIV/AIDS.
Donating or giving blood
Percent who believe in some likelihood of transmission
CI-2.5% Herek Survey CI+2.5% SCHAC Survey
more misconceptions
Level of Comfort with Persons who have HIV/AIDS
66.2
74.4
69.4
71
69.7
77.6
72.8
74.3
72.2
80.8
76.2
77.5
66
77.6
69.3
53
0 10 20 30 40 50 60 70 80 90
A child in your family attending school with a personwho has HIV/AIDS
Working with an office co-worker who has HIV/AIDS
Having a neighborhood grocer who has HIV/AIDS
Drinking out of a washed glass in a restaurant ifsomeone with HIV/AIDS had drunk out of the same
glass a few days earlier
Percent feeling comfortable
CI-2.5% Herek Survey CI+2.5% SCHAC Survey
Bars in pink represent 95% confidence intervals for national probability survey
Negative Feelings toward PWAs
12.1
17.1
13.2
14.8
20.2
16
17.5
23.2
18.8
10.8
16.6
13.7
0 5 10 15 20 25
Angry
Afraid
Disgusted (sickened)
Percent responding "agree" or "somewhat agree"
CI-2.5% Herek Survey CI+2.5% SCHAC Survey
Bars in pink represent 95% confidence intervals for national probability survey
Summary
Compared to the national probability sample, the SCHAC sample of African American adults in SC– Displayed more avoidant intentions in 2 out of 3
measures– Were less likely to blame PLWHA– Displayed more misconceptions about
transmission in 3 out of 5 measures– Indicated much less comfort with PLWHA in only 1
out of 4 measures– Indicated somewhat less negative emotions in 2
out of 3 measures
A conceptual model of HIV-related
stigma
Conceptual Model of Psychological Reactions to Stigma
CognitiveResponses
Approach/AvoidanceBehaviors
EmotionalReactions
AvoidanceAvoidanceof PLWHAof PLWHA
Comfort-Comfort-PLWHAPLWHA
Negative Negative Emotions-Emotions-
PLWHAPLWHA
BlameBlame
Belief inBelief inCasual Casual ContactContact
Cognitive Affective Behavioral
Components of Stigma in General Survey
AvoidanceAvoidanceof PLWHAof PLWHA
ß=.26*
ß=.34*
ß=-.43*
ß=.29*
Step 1Step 2
R2=.25,F(2,367)=59.65,
p<.01
R2=.49,Fchange(2,365)=85.46,
p<.01 *p<.05
Hierarchical MultipleRegression PredictingAvoidance Intentions
BlameBlame
Belief inBelief inCasual Casual ContactContact
Comfort-Comfort-PLWHAPLWHA
Negative Negative Emotions-Emotions-
PLWHAPLWHA
STUDY 1
AvoidanceAvoidanceof PLWHAof PLWHA
Comfort-Comfort-PLWHAPLWHA
Negative Negative Emotions-Emotions-
PLWHAPLWHA
Belief inBelief inCasual Casual ContactContact
BlameBlameß=-.48*
ß=.30*
ß=.04
ß=.11*
Step 1Step 2
R2=.48,F(2,367)=166.76,
p<.01
R2=.49,Fchange(2,365)=3.51,
p<.01 *p<.05
Hierarchical MultipleRegression PredictingAvoidance Intentions
STUDY 1
Summary
• Avoidance intentions are related to both cognitive and affective components of stigma
• Affective components seem to account for more unique variance in avoidance intentions
An intervention evaluation
Intervention• Play about HIV
infection in African American families
• Themes:– Forgiveness– Family support– Tolerance– It could happen to you
Design of Intervention Evaluation
RandomAssignment
RecruitmentFrom the
African AmericanCommunity
Delay Play Discussion Survey
Survey Play Discussion
Constructs Measured in the Intervention Survey
• Empathy for persons living with HIV/AIDS (PLWHA) (Empathy for persons living with HIV/AIDS (PLWHA) (.82).82)• Negative emotions for PLWHA (Negative emotions for PLWHA (.77).77)• Blame (Blame (.50).50)• Beliefs in transmission via causal contact (Beliefs in transmission via causal contact (.82).82)• Avoidance tendencies regarding PLWHA (Avoidance tendencies regarding PLWHA (.82).82)• Attitudes about being tested (Attitudes about being tested (.89).89)• Motivation to control prejudice regarding PLWHA (Motivation to control prejudice regarding PLWHA (.79).79)• Superstitious contagion beliefs (Superstitious contagion beliefs ())• Attitudes toward MSM and WSW (Attitudes toward MSM and WSW (.87, .87, .93).93)• Personal contact with MSM and WSW (Personal contact with MSM and WSW ())• Positive religious beliefs regarding PLWHA (Positive religious beliefs regarding PLWHA (.67).67)• Support for coercive social policies (Support for coercive social policies (.80).80)
Summary of the Analyses from the Intervention Survey
• There were no statistically significant differences between There were no statistically significant differences between the two intervention conditions across any of the the two intervention conditions across any of the constructsconstructs
• Participants in intervention study were from Richland County Participants in intervention study were from Richland County (pop=334,609)(pop=334,609)
• 3/4 of General Survey sample were from counties with less than 3/4 of General Survey sample were from counties with less than 100,000 population100,000 population
• Comparisons between measures common across the Comparisons between measures common across the Intervention Survey and the General Survey revealed that Intervention Survey and the General Survey revealed that participants in the intervention participants in the intervention blamed PLWHAs lessblamed PLWHAs less than than people from counties less than 100,000; they also indicated people from counties less than 100,000; they also indicated weaker avoidance intentionsweaker avoidance intentions than people from counties less than people from counties less than 100,000than 100,000
• Ironically, participants in the intervention displayed certain Ironically, participants in the intervention displayed certain negative emotions morenegative emotions more than all others from the General Survey than all others from the General Survey
Examining the HIV-related stigmaconceptual model
AvoidanceAvoidanceof PLWHAof PLWHA
Empathy-Empathy-PLWHAPLWHA
Negative Negative Emotions-Emotions-
PLWHAPLWHA
BlameBlame
Belief inBelief inCasual Casual ContactContact
Cognitive Affective Behavioral
Components of Stigma in Intervention Survey
AvoidanceAvoidanceof PLWHAof PLWHA
ß=.22†
ß=.07
ß=-.23*
ß=.33*
Step 1Step 2
R2=.06,F(2,72)=2.16,
P=.12
R2=.19,Fchange(2,70)=5.85,
p<.01 *p<.05†p<.07
Hierarchical MultipleRegression PredictingAvoidance Intentions
BlameBlame
Belief inBelief inCasual Casual ContactContact
Empathy-Empathy-PLWHAPLWHA
Negative Negative Emotions-Emotions-
PLWHAPLWHA
STUDY 2
AvoidanceAvoidanceof PLWHAof PLWHA
Empathy-Empathy-PLWHAPLWHA
Negative Negative Emotions-Emotions-
PLWHAPLWHA
Belief inBelief inCasual Casual ContactContact
BlameBlameß=-.24*
ß=.35*
ß=.05
ß=-.01
Step 1Step 2
R2=.19,F(2,72)=8.41,
p<.01
R2=.19,Fchange(2,70)<1,
NS *p<.05
Hierarchical MultipleRegression PredictingAvoidance Intentions
STUDY 2
Summary
• Affective components were more strongly related to variance in avoidance intentions than cognitive components of stigma
Why should prevention
researchers be concerned with HIV-
related stigma?
Attitude Attitude Toward HIVToward HIV
TestingTesting
ß=-.30*
ß=.11
ß=.38*
ß=.01
Step 1Step 2
R2=.09,F(2,77)=3.34
P<.05
R2=.22,Fchange(2,75)=6.21,
p<.01 *p<.05
Hierarchical MultipleRegression PredictingAttitudes toward HIVTesting
BlameBlame
Belief inBelief inCasual Casual ContactContact
Empathy-Empathy-PLWHAPLWHA
Negative Negative Emotions-Emotions-
PLWHAPLWHA
STUDY 2
Attitude Attitude Toward HIVToward HIV
TestingTesting
Empathy-Empathy-PLWHAPLWHA
Negative Negative Emotions-Emotions-
PLWHAPLWHA
Belief inBelief inCasual Casual ContactContact
BlameBlameß=.43*
ß=-.04
ß=.-.19
ß=.06
Step 1Step 2
R2=.19,F(2,77)=8.88,
p<.01
R2=.22,Fchange(2,75)=1.47,
NS *p<.05
Hierarchical MultipleRegression PredictingAttitudes toward HIVTesting
STUDY 2
Summary
• Empathy for PLWHAs was a relatively strong predictor of attitudes toward testing
• People who felt empathy/compassion for PLWHAs held more positive attitudes toward being tested themselves or encouraging their family & friends to be tested
Future Directions
• Our analyses of survey data suggest that anti-stigma interventions might focus upon encouraging empathy for PLWHAs
• Interventions that encourage empathy/compassion for PLWHAs may also have an impact upon attitudes toward HIV testing
• A focus upon empathy/compassion may be well received in faith communities
Special thanks to the following people who Special thanks to the following people who helped in data analyses for this projecthelped in data analyses for this project
• Jamie HughesJamie Hughes• Leah PryorLeah Pryor
Variables1 2 3 4 5 6 7 8
1 Avoidant Intentions 1.00 -0.28 0.34 0.11 0.25 -0.11 -0.20 0.052 Empathy toward PLWHA -0.28 1.00 -0.09 0.11 -0.27 0.44 0.36 0.113 Negative Emotions toward PLWHA 0.34 -0.09 1.00 0.31 0.42 -0.08 -0.22 0.064 Misconceptions about Transmission 0.11 0.11 0.31 1.00 0.13 0.05 -0.11 0.055 Blame 0.25 -0.27 0.42 0.13 1.00 -0.31 -0.37 -0.076 Attitudes about Being Tested -0.11 0.44 -0.08 0.05 -0.31 1.00 0.21 0.047 Motivations to Control Prejudice -0.20 0.36 -0.22 -0.11 -0.37 0.21 1.00 -0.018 Contamination Sensitivity 0.05 0.11 0.06 0.05 -0.07 0.04 -0.01 1.009 Pro-HIV Religious Values -0.21 0.26 -0.17 0.00 -0.12 0.17 0.28 -0.15
10 Attitudes toward MSM -0.32 0.22 -0.37 -0.33 -0.16 -0.06 0.21 -0.0211 Endorsing Coercive Social Policies 0.40 -0.22 0.50 0.35 0.61 -0.20 -0.52 -0.0812 Age 0.14 0.27 0.17 0.07 -0.12 -0.03 -0.09 -0.0613 Gender 0.06 0.09 0.11 0.24 -0.14 0.21 -0.10 0.0614 Income Level 0.12 0.05 -0.04 -0.19 -0.08 -0.05 0.01 -0.1415 Church Attendance -0.09 -0.02 0.06 -0.01 0.22 -0.06 -0.05 -0.18
9 10 11 12 13 14 151 Avoidant Intentions -0.21 -0.32 0.40 0.14 0.06 0.12 -0.092 Empathy toward PLWHA 0.26 0.22 -0.22 0.27 0.09 0.05 -0.023 Negative Emotions toward PLWHA -0.17 -0.37 0.50 0.17 0.11 -0.04 0.064 Misconceptions about Transmission 0.00 -0.33 0.35 0.07 0.24 -0.19 -0.015 Blame -0.12 -0.16 0.61 -0.12 -0.14 -0.08 0.226 Attitudes about Being Tested 0.17 -0.06 -0.20 -0.03 0.21 -0.05 -0.067 Motivations to Control Prejudice 0.28 0.21 -0.52 -0.09 -0.10 0.01 -0.058 Contamination Sensitivity -0.15 -0.02 -0.08 -0.06 0.06 -0.14 -0.189 Pro-HIV Religious Values 1.00 0.17 -0.19 -0.01 -0.03 -0.02 -0.01
10 Attitudes toward MSM 0.17 1.00 -0.30 0.07 -0.10 0.03 -0.1811 Endorsing Coercive Social Policies -0.19 -0.30 1.00 0.20 -0.08 0.01 0.1012 Age -0.01 0.07 0.20 1.00 0.08 0.31 0.0713 Gender -0.03 -0.10 -0.08 0.08 1.00 -0.10 -0.0614 Income Level -0.02 0.03 0.01 0.31 -0.10 1.00 -0.0515 Church Attendance -0.01 -0.18 0.10 0.07 -0.06 -0.05 1.00
Correlation Matrix from Intervention Study
Correlations in yellow are statistically significant, p < .05