Kudos to Michael Relf, associate dean for Global and Community Health Affairs, Laura Nyblade (Research Triangle International), Mrema Kilonzo (Muhimbili University of Health and Allied Sciences) and their entire team for the submission of their Multi-PI NIH/Fogarty International Center R21 application entitled: “Efficacy Testing of a Culturally Relevant Stigma Intervention in WLWH in Tanzania.” This proposal requests funding for a two-year period with a project start date of June 1, 2021.

HIV-related stigma, especially internalized stigma, yields several negative outcomes. According to UNAIDS, only 62% of Tanzanians living with HIV are virologically suppressed, with gender inequality and HIV-related stigma acting as major barriers. Despite the negative impact of stigma on HIV outcomes, culturally and contextually sensitive interventions to mitigate the negative effects of internalized stigma associated with HIV among women living with HIV (WLWH) are limited and critically needed in Tanzania.

In Tanzania, where 80% of the population lives in rural areas and HIV is the third leading cause of death, an estimated 810,000 women are living with HIV. 4.5% of Tanzanian adults between the ages of 15 and 49 were living with HIV with the prevalence being higher among women (♀ = 5.5%:♂=3.4%). Additionally, the prevalence of HIV is highest among women aged 45-49, at 12% (compared with 8.4% among men of this age). Further, there are disproportionate rates of new infections among young women in Tanzania (ages 15-24) compared to their male counterparts of the same age. The 2016-2017 Tanzania Impact Survey identified that women between the ages of 15 and 39 are more than twice as likely to be living with HIV as their male counterparts. Thus, in recruiting WLWH for this study, we will purposively recruit based on geography (urban and rural) and ensure that WLWH across the age spectrum are sufficiently represented.

Labda Siku Moja: Sauti za Wanawake Wanaoishi na VVU (Maybe Someday: Voices of Women Living with HIV) was identified as a culturally acceptable internalized stigma reduction intervention among Tanzanian WLWH. In Tanzania, where storytelling is an important part of the oral literature and culture, the stories of the Labda Siku Moja can help individuals acknowledge and reflect upon new truths in relation to self and their world producing transformations and insights that endure. Thus, the specific aims for this proposed study are to:

Aim 1: Assess the feasibility (recruitment and retention metrics; time to administer and completeness of study instruments; fidelity to intervention; evaluation of study processes) of implementing an internalized stigma reduction intervention among urban and rural Tanzanian WLWH; and

Aim 2: Test preliminary efficacy and determine effect sizes of an internalized stigma reduction intervention among urban and rural WLWH (N = 160) using a 2x4 repeated measures randomized controlled trial (2 treatments x 4 time points [baseline, 30 days, 90 days, 180 days]) to determine if the Labda Siku Moja intervention results in reduced stigma and improved self-esteem and coping self-efficacy (proximal targets).