The Positive Living Program: Development and Pilot Evaluation of a Multimedia Behavioral Intervention to Address HIV-Related Stigma and Depression Among African-Immigrant People Living With HIV in a Large, Northwestern U.S. Metropolitan Area

A citizen science approach to develop a digital intervention to reduce HIV stigma and promote HIV self-testing among adolescents and young adults: a mixed methods analysis from Kazakhstan

INTRODUCTION

Kazakhstan has one of the fastest-growing HIV epidemics in the world, with increasing rates among adolescents and young adults (AYA). Innovative strategies are needed to increase HIV testing uptake and decrease HIV stigma among AYA. Citizen science, defined as the active engagement of the general public in scientific research tasks, promotes and facilitates community engagement throughout the research process. This citizen science study used crowdsourcing to engage AYA in Kazakhstan to develop a digital intervention to reduce HIV stigma and promote HIV self-testing. Our objectives in this paper are to describe the approach used, its feasibility and acceptability, and AYA motivations for and lessons learned collaborating on the study.

METHODS

From October 2021 to July 2022, in collaboration with a Community Collaborative Research Board and a Youth Advisory Board, we developed an open call requesting multimedia submissions to reduce HIV testing stigma. Eligible submissions were separated by age group (13-19 or 20-29 years) and judged by a panel composed of AYA (n = 23), healthcare professionals (n = 12), and representatives from the local government and non-governmental organizations (n = 17). Each entry was reviewed by at least four judges and ranked on a 5-point scale. The top 20 open call contestants were asked to submit self-recordings sharing their motivation for and experience participating in the contest and lessons learned. Descriptive statistics were calculated for quantitative data. Qualitative data were coded using open coding.

RESULTS

We received 96 submissions from 77 youth across Kazakhstan. Roughly, three-quarters (n = 75/96) of entries met judging eligibility criteria. Of the eligible entries, over half (n = 39/75) scored 3.5 or higher on a 5-point scale (70.0%). The most frequent types of entries were video (n = 36/96, 37.5%), image (n = 28/96, 29.2%) and text (n = 24/96, 25.0%). AYA's primary motivations for collaborating on the study included a desire to improve society and help youth. The main challenges included creating content to address complex information using simple language, finding reliable information online and technological limitations.

CONCLUSIONS

Crowdsourcing was feasible and highly acceptable among AYA in Kazakhstan. Citizen science approaches hold great promise for addressing the increasingly complex health and social challenges facing communities today.

Developing an app-based self-management program for people living with HIV: a randomized controlled pilot study during the COVID-19 pandemic

People living with human immunodeficiency virus (PLWH) in Korea demonstrate insufficient self-management behaviors. Especially during pandemics such as COVID-19, technology-based self-management programs are needed to overcome time and space limitations. The purpose of this study was to evaluate the effects of a self-management program using a mobile app (Health Manager) on self-management outcomes among PLWH in Korea. A randomized controlled pilot trial was performed and participants were enrolled in the infectious outpatient clinic of a single hospital. The intervention group used the mobile app for 4 weeks, while the control group received self-management education materials in a portable document format. The online self-report questionnaire assessed primary outcomes including self-efficacy for self-management, self-management behaviors, and medication adherence, and secondary outcomes including perceived health status, depression, and perceived stigma. Thirty-three participants were randomly assigned to the intervention (n = 17) or the control group (n = 16). In the intention-to-treat analysis, self-efficacy for self-management and self-management behaviors increased, while perceived stigma decreased. The app-based self-management program could be considered a helpful strategy to improve self-management outcomes among PLWH and reduce their perceived stigma during the pandemic. Further studies with larger samples and longer follow-ups are needed.Trial registration: Clinical Research Information Service, KCT0004696 [04/02/2020].

Harambee! 2.0: The Impact of HIV-Related and Intersectional Stigmas on HIV Testing Behaviors Among African Immigrant Communities in Seattle, Washington

African immigrants are disproportionately affected by HIV compared to U.S.-born individuals, and early HIV testing is the key challenge in ending the HIV epidemic in these communities. HIV-related stigma appears to be the most significant barrier to testing for HIV among African communities in King County, WA. In this formative study, we conducted thirty key informant interviews and five focus group discussions (n = total 72 participants) with Ethiopian, Somali, and Eritrean people living with HIV, health professionals, religious and other community leaders, and lay community members in King County to better understand HIV-related and intersectional stigmas' impact on HIV testing behaviors. We used inductive coding and thematic analysis. Participants from all communities reported similar themes for HIV-related and intersectional stigmas' influences on HIV testing behaviors. Misconceptions or poor messaging, e.g., regarding treatability of HIV, as well as normative or religious/moral beliefs around pre/extramarital sex contributed to HIV-related stigma. Intersecting identities such as immigrant status, race/ethnicity, and having a non-English language preference, all intermingle to further influence access to the U.S. healthcare system, including for HIV testing. These findings can be used to inform future research on community-led approaches to addressing early HIV testing amongst African immigrant communities.