An Intervention to Reduce HIV-Related Stigma Among African American Communities in South Carolina

1. An Intervention to Reduce HIV-Related Stigma Among African American Communities in South Carolina Presentation at the 2005 National HIV Prevention Conference 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

2. Outline of Today’s Talk • Background - HIV in South Carolina • South Carolina HIV/AIDS Council • General Survey 2003-2004 • Some comparisons of the General Survey to a national probability sample • A conceptual model of stigma • 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

3. 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).

4. 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

5. General Survey 2003-2004 • 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

6. more avoidance SCHAC survey items not in Herek survey Bars in pink represent 95% confidence intervals for national probability survey

7. Bars in pink represent 95% confidence intervals for national probability survey

8. more misconceptions Bars in pink represent 95% confidence intervals for national probability survey

9. Bars in pink represent 95% confidence intervals for national probability survey

10. Bars in pink represent 95% confidence intervals for national probability survey

11. 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

12. A conceptual model of HIV-related stigma

13. Conceptual Model of Psychological Reactions to Stigma Cognitive Responses Approach/ Avoidance Behaviors Emotional Reactions

14. Components of Stigma in General Survey Cognitive Affective Behavioral Blame Comfort- PLWHA Avoidance of PLWHA Belief in Casual Contact Negative Emotions- PLWHA

15. STUDY 1 Hierarchical Multiple Regression Predicting Avoidance Intentions Step 2 Step 1 Blame Comfort- PLWHA ß=.26* ß=-.43* Avoidance of PLWHA ß=.29* Belief in Casual Contact Negative Emotions- PLWHA ß=.34* R2=.49, Fchange(2,365)=85.46, p<.01 R2=.25, F(2,367)=59.65, p<.01 *p<.05

16. STUDY 1 Hierarchical Multiple Regression Predicting Avoidance Intentions Step 2 Step 1 Blame Comfort- PLWHA ß=-.48* ß=.04 Avoidance of PLWHA ß=.11* Belief in Casual Contact Negative Emotions- PLWHA ß=.30* R2=.49, Fchange(2,365)=3.51, p<.01 R2=.48, F(2,367)=166.76, p<.01 *p<.05

17. 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

18. An intervention evaluation

19. Intervention • Play about HIV infection in African American families • Themes: • Forgiveness • Family support • Tolerance • It could happen to you

20. Random Assignment Design of Intervention Evaluation Survey Play Discussion Recruitment From the African American Community Delay Play Discussion Survey

21. Constructs Measured in the Intervention Survey • Empathy for persons living with HIV/AIDS (PLWHA) (=.82) • Negative emotions for PLWHA (=.77) • Blame (=.50) • Beliefs in transmission via causal contact (=.82) • Avoidance tendencies regarding PLWHA (=.82) • Attitudes about being tested (=.89) • Motivation to control prejudice regarding PLWHA (=.79) • Superstitious contagion beliefs () • Attitudes toward MSM and WSW (=.87, =.93) • Personal contact with MSM and WSW () • Positive religious beliefs regarding PLWHA (=.67) • Support for coercive social policies (=.80)

22. Summary of the Analyses from the Intervention Survey • There were no statistically significant differences between the two intervention conditions across any of the constructs • Participants in intervention study were from Richland County (pop=334,609) • 3/4 of General Survey sample were from counties with less than 100,000 population • Comparisons between measures common across the Intervention Survey and the General Survey revealed that participants in the intervention blamed PLWHAs less than people from counties less than 100,000; they also indicated weaker avoidance intentions than people from counties less than 100,000 • Ironically, participants in the intervention displayed certain negative emotions more than all others from the General Survey

23. Examining the HIV-related stigmaconceptual model

24. Components of Stigma in Intervention Survey Cognitive Affective Behavioral Blame Empathy- PLWHA Avoidance of PLWHA Belief in Casual Contact Negative Emotions- PLWHA

25. STUDY 2 Hierarchical Multiple Regression Predicting Avoidance Intentions Step 2 Step 1 Blame Empathy- PLWHA ß=.22† ß=-.23* Avoidance of PLWHA ß=.33* Belief in Casual Contact Negative Emotions- PLWHA ß=.07 R2=.19, Fchange(2,70)=5.85, p<.01 R2=.06, F(2,72)=2.16, P=.12 *p<.05 †p<.07

26. STUDY 2 Hierarchical Multiple Regression Predicting Avoidance Intentions Step 2 Step 1 Blame Empathy- PLWHA ß=-.24* ß=.05 Avoidance of PLWHA ß=-.01 Belief in Casual Contact Negative Emotions- PLWHA ß=.35* R2=.19, Fchange(2,70)<1, NS R2=.19, F(2,72)=8.41, p<.01 *p<.05

27. Summary • Affective components were more strongly related to variance in avoidance intentions than cognitive components of stigma

28. Why should prevention researchers be concerned with HIV-related stigma?

29. STUDY 2 Hierarchical Multiple Regression Predicting Attitudes toward HIV Testing Step 2 Step 1 Blame Empathy- PLWHA ß=-.30* ß=.38* Attitude Toward HIV Testing ß=.01 Belief in Casual Contact Negative Emotions- PLWHA ß=.11 R2=.22, Fchange(2,75)=6.21, p<.01 R2=.09, F(2,77)=3.34 P<.05 *p<.05

30. STUDY 2 Hierarchical Multiple Regression Predicting Attitudes toward HIV Testing Step 2 Step 1 Blame Empathy- PLWHA ß=.43* ß=.-.19 Attitude Toward HIV Testing ß=.06 Belief in Casual Contact Negative Emotions- PLWHA ß=-.04 R2=.22, Fchange(2,75)=1.47, NS R2=.19, F(2,77)=8.88, p<.01 *p<.05

31. 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

32. 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

33. Special thanks to the following people who helped in data analyses for this project • Jamie Hughes • Leah Pryor

34. Correlation Matrix from Intervention Study Correlations in yellow are statistically significant, p < .05