Kudos to Michael Relf and his entire team for the submission of their multi-PI, subcontract proposal with the Medical University of South Carolina entitled “A multi-site RCT of a stigma reduction intervention for HIV-infected women." This proposal requests funding for a five-year period with a start date of July 1, 2017.

Abstract: Stigma as it is experienced by women living with HIV infection creates a cascade of adverse outcomes: poor self-esteem and self-efficacy, depression, and increased post­traumatic stress disorder. Stigma impairs effective HIV prevention behavior, as a woman may not insist that a male partner use a condom, fearing that this will signal her seropositive status; it also impairs medication adherence, because women may not want to take their medications in front of others, fearing that this will lead to questions about what they are taking and why. As a mechanism of action, stigma represents a barrier to prevention behaviors and medication adherence, and is thus a social determinant impacting transmission and treatment. Stigma is persistent, and efforts to ameliorate it among the general public have been largely ineffective. In our previous work, we implemented a feasible, acceptable, and effective video based intervention, “Maybe Someday,” aimed at reducing internalized stigma and improving self-esteem and coping self-efficacy in women living with HIV. The success of this project, and the need to include other groups of women – particularly Spanish speakers – led to the current proposal to test the efficacy of the intervention in a fully powered RCT across multiple sites and with a majority of African American and Hispanic women. We propose to use a repeated measures randomized wait­list control group design to compare those receiving the Maybe Someday (“Algún Día, Será Posible” in Spanish) intervention to a wait­list control group to determine the intervention’s ability to reduce stigma, improve coping self-efficacy and self-esteem, improve effective HIV prevention behaviors, and improve antiretroviral adherence with 240 women living with HIV infection in El Paso, TX; Washington, DC; Durham, NC; and Charleston, SC. We will use the ADAPT­ITT approach to adapt the video for use with Spanish-­speaking women, and will test the following hypotheses: Compared to a wait-­list control group: Hypothesis 1: Participants in the video intervention condition will report reduced internalized stigma, and increased coping self-efficacy and self-esteem, across racial and ethnic categories of participants at 30, 75, and 120 day assessment points; and Hypothesis 2: Participants in the video intervention condition will report improved HIV prevention behaviors and ART regimen adherence. Hypothesis 3: Effect sizes of the Spanish and English versions of the intervention will be comparable, and there will be no differences in terms of race or ethnicity with respect to study outcomes.