Finding Respect and Ending Stigma around HIV (FRESH) intervention in the Dominican Republic: results from a pilot study

Abstract

Background Stigma is a deleterious force that is associated with poor health outcomes among people with HIV (PWH). The Finding Respect and Ending Stigma around HIV (FRESH) intervention is designed to combat HIV and related stigmas about PWH and their care providers. To evaluate the effects of the Spanish-language FRESH in the Dominican Republic, our team conducted a pilot trial, informed by the stepped-wedge model, at two HIV clinics to ascertain signals of potential value for PWH.<br /> Methods Clinics were randomized to first and second receipt of the intervention; the intervention was delivered over 2 days. In-person tablet-based digital surveys, including validated measures of stigma and discrimination, were administered to PWH (2021-2022, N = 419) every 6 months aggregated to pre- and post-intervention periods for analysis. Analysis of variance (ANOVA) and general linear modelling were used to evaluate differences in stigma scores. All data collection occurred after an HIV clinic visit. Statistical analyses were performed using SPSS.<br /> Results Mean age of participants was 33.86 (standard deviation [SD] = 9.14; range = 18-70); respondents predominantly identified as male (N = 396, 94.5%) and multiracial (N = 330, 90.5%). Significant differences were observed across time, with decreases from pre- to post-intervention in public stigma (mean [M] = 3.92, SD = 1.25 to M = 3.47, SD = 1.41, p < .001) and perceived sexual orientation discrimination (M = .23, SD = .27 to M = .10, SD = .18, p < .001). Significant differences between clinics were also evident, with higher scores in clinic A compared to clinic B in disclosure concerns (M = 4.31, SD = .84 vs. M = 3.68, SD = 1.26, p < .001), perceived sexual orientation discrimination (M = .17, SD = .22 vs. M = .12, SD = .22, p = .030), and perceived discrimination related to race/ethnicity (M = .11, SD = .19 vs. M = .05, SD = .15, p = .002). The viral suppression rate in these clinics improved between pre-intervention and post-intervention periods, from 78 to 82%, but did not reach statistical significance.<br /> Conclusions Substantive differences in clinics could have impacted the intervention's delivery and impacts. While there were significant associations of intervention experience with reductions in some forms of stigma among PWH, results should be extended cautiously considering the small size of this pilot. Data collection procedures were feasible and acceptable, and evidence was found to warrant full-scale testing of the intervention.