Reducing AIDS Stigma Among Health Professionals in India

NCT02101697 | Completed DMC

• 1 other identifier: R01MH093257
• Study Type: interventional
• Target: 3,733
• Locations: 1 country
• Sites: 1

Brief Summary

This Randomized Controlled Trial has been designed to test the efficacy of a behavioral intervention to reduce HIV-related stigma among nursing students and ward attendants in 16 sites in South India and 8 sites in North India.

Conditions

Stigmatization

Keywords

reduce; Indian health providers

Outcome Measures

Primary Outcomes (2)

• behavioral manifestations of HIV-related stigma

  Evaluate the efficacy of the intervention in a RCT, among nursing students and ward attendants on behavioral manifestations of AIDS stigma including their endorsement of coercive policies, behavioral intentions to discriminate, and non/stigmatizing provider-patient interactions, using face-to-face interviews, computer-based assessments, and ratings by behavioral observers at pre-, 6- and 12 month follow-up.

  one year

• instrumental and symbolic stigma

  Evaluate the efficacy of the intervention in a RCT, among nursing students and ward attendants on the factors underlying stigma proposed by our conceptual model and targeted in the intervention modules, including fears and misconceptions regarding casual transmission (instrumental stigma), and negative attitudes toward marginalized, vulnerable groups (symbolic stigma), which have consistently been found to drive the behavioral manifestations of AIDS stigma and discrimination.

  one year

Study Arms (2)

HIV Stigma Reduction Intervention

EXPERIMENTAL

The HIV stigma reduction arm group will participate in a promising intervention designed to reduce HIV stigma among health professionals. The intervention builds on results of our previous research, identifying prevalence and drivers of stigma and discrimination in Indian healthcare settings among PLHIV, health care providers, and uninfected patients.The HIV stigma reduction intervention consists of two computer-administered sessions and one group session.

Behavioral: HIV Stigma Reduction Intervention

Time Matched Control Group

PLACEBO COMPARATOR

The time-matched control group will also receive three sessions; two administered by computers and one in small group format to control for attention effects. However, rather than AIDS stigma, the content will be focused on diabetes management (a disease not considered to be stigmatized).

Behavioral: HIV Stigma Reduction Intervention

Interventions

HIV Stigma Reduction Intervention BEHAVIORAL

The HIV stigma reduction intervention consists of two computer-administered sessions and one group session. Session 1. (approx. 60 min). Introduction of the concepts of stigma and discrimination, vulnerable populations and symbolic stigma delivered in an interactive tablet format, using games and videos. Session 2. (approx. 60 min). Interactive activities to address HIV transmission myths and misconceptions and the importance of universal precautions. Session 3. (approx 90 min). Patient interaction skills. In person interactive group session co-facilitated by PLHIV and staff focusing on skills building through role-plays and feedback. Our previous research has found that these modules address factors identified as contributing to health professionals' stigma.

HIV Stigma Reduction Intervention; Time Matched Control Group

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• For Nursing Students:
• being enrolled as a 2nd year nursing student in one of the study colleges,
• being 18 years or older,
• being able and willing to participate in the intervention and all assessments.
• For ward attendants:
• having worked as ward attendant at one of the study hospitals for at least a year
• being 18 years or older,
• being able and willing to participate in the intervention and all assessments.

You may not qualify if:

• a) Unwilling or unable to participate

Sponsors & Collaborators

• University of California, San Francisco: lead
• National Institute of Mental Health (NIMH): collaborator

Study Sites (1)

St. John's Research Institute/St John's Medical College & Hospital

Bangalore, Karnataka, 560 034, India

Location

Related Publications (17)

• Shah SM, Heylen E, Srinivasan K, Perumpil S, Ekstrand ML. Reducing HIV stigma among nursing students: a brief intervention. West J Nurs Res. 2014 Nov;36(10):1323-37. doi: 10.1177/0193945914523685. Epub 2014 Feb 25.

  PMID: 24569699 BACKGROUND

• Ekstrand ML, Ramakrishna J, Bharat S, Heylen E. Prevalence and drivers of HIV stigma among health providers in urban India: implications for interventions. J Int AIDS Soc. 2013 Nov 13;16(3 Suppl 2):18717. doi: 10.7448/IAS.16.3.18717.

  PMID: 24242265 BACKGROUND

• Steward WT, Bharat S, Ramakrishna J, Heylen E, Ekstrand ML. Stigma is associated with delays in seeking care among HIV-infected people in India. J Int Assoc Provid AIDS Care. 2013 Mar-Apr;12(2):103-9. doi: 10.1177/1545109711432315. Epub 2012 Jan 26.

  PMID: 22282878 BACKGROUND

• Steward WT, Chandy S, Singh G, Panicker ST, Osmand TA, Heylen E, Ekstrand ML. Depression is not an inevitable outcome of disclosure avoidance: HIV stigma and mental health in a cohort of HIV-infected individuals from Southern India. Psychol Health Med. 2011 Jan;16(1):74-85. doi: 10.1080/13548506.2010.521568.

  PMID: 21218366 BACKGROUND

• Nyblade L, Jain A, Benkirane M, Li L, Lohiniva AL, McLean R, Turan JM, Varas-Diaz N, Cintron-Bou F, Guan J, Kwena Z, Thomas W. A brief, standardized tool for measuring HIV-related stigma among health facility staff: results of field testing in China, Dominica, Egypt, Kenya, Puerto Rico and St. Christopher & Nevis. J Int AIDS Soc. 2013 Nov 13;16(3 Suppl 2):18718. doi: 10.7448/IAS.16.3.18718.

  PMID: 24242266 BACKGROUND

• Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc. 2009 Aug 6;12:15. doi: 10.1186/1758-2652-12-15.

  PMID: 19660113 BACKGROUND

• Varas-Diaz N, Marzan-Rodriguez M. The emotional aspect of AIDS stigma among health professionals in Puerto Rico. AIDS Care. 2007 Nov;19(10):1247-57. doi: 10.1080/09540120701405403.

  PMID: 18071968 BACKGROUND

• Varas-Diaz N, Neilands TB. Development and validation of a culturally appropriate HIV/AIDS Stigma Scale for Puerto Rican health professionals in training. AIDS Care. 2009 Oct;21(10):1259-70. doi: 10.1080/09540120902804297.

  PMID: 20024702 BACKGROUND

• Ekstrand ML, Bharat S, Ramakrishna J, Heylen E. Blame, symbolic stigma and HIV misconceptions are associated with support for coercive measures in urban India. AIDS Behav. 2012 Apr;16(3):700-10. doi: 10.1007/s10461-011-9888-z.

  PMID: 21290175 BACKGROUND

• Li L, Liang LJ, Lin C, Wu Z, Wen Y. Individual attitudes and perceived social norms: Reports on HIV/AIDS-related stigma among service providers in China. Int J Psychol. 2009 Dec;44(6):443-50. doi: 10.1080/00207590802644774.

  PMID: 20090857 BACKGROUND

• Li L, Lin C, Wu Z, Wu S, Rotheram-Borus MJ, Detels R, Jia M. Stigmatization and shame: consequences of caring for HIV/AIDS patients in China. AIDS Care. 2007 Feb;19(2):258-63. doi: 10.1080/09540120600828473.

  PMID: 17364408 BACKGROUND

• Li L, Wu Z, Wu S, Zhaoc Y, Jia M, Yan Z. HIV-related stigma in health care settings: a survey of service providers in China. AIDS Patient Care STDS. 2007 Oct;21(10):753-62. doi: 10.1089/apc.2006.0219.

  PMID: 17949274 BACKGROUND

• Li L, Wu Z, Zhao Y, Lin C, Detels R, Wu S. Using case vignettes to measure HIV-related stigma among health professionals in China. Int J Epidemiol. 2007 Feb;36(1):178-84. doi: 10.1093/ije/dyl256. Epub 2006 Dec 14.

  PMID: 17175545 BACKGROUND

• Bharat S. Facing the HIV / AIDS challenge: a study on household and community responses. Health Millions. 1998 Jan-Feb;24(1):15-6, 19.

  PMID: 12348525 BACKGROUND

• Mahendra VS, Gilborn L, Bharat S, Mudoi R, Gupta I, George B, Samson L, Daly C, Pulerwitz J. Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective. SAHARA J. 2007 Aug;4(2):616-25. doi: 10.1080/17290376.2007.9724883.

  PMID: 18071613 BACKGROUND

• Noar SM, Black HG, Pierce LB. Efficacy of computer technology-based HIV prevention interventions: a meta-analysis. AIDS. 2009 Jan 2;23(1):107-15. doi: 10.1097/QAD.0b013e32831c5500.

  PMID: 19050392 BACKGROUND

• Lightfoot M, Rotheram-Borus MJ, Comulada WS, Reddy VS, Duan N. Efficacy of brief interventions in clinical care settings for persons living with HIV. J Acquir Immune Defic Syndr. 2010 Mar;53(3):348-56. doi: 10.1097/QAI.0b013e3181c429b3.

  PMID: 19996978 BACKGROUND

MeSH Terms

Conditions

Stereotyping

Condition Hierarchy (Ancestors)

Social Behavior; Behavior

Study Officials

• Maria L Ekstrand, PhD

  University of California, San Francisco

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: PARTICIPANT
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: March 27, 2014
• First Posted: April 2, 2014
• Study Start: July 1, 2014
• Primary Completion: August 1, 2019
• Study Completion: August 1, 2019
• Last Updated: September 20, 2019

Record last verified: 2019-09

Locations

IN (1)