Background
Retention in care remains a significant challenge for People Living with HIV (PLHIV) in Tanzania, possibly worsened by internalized HIV stigma and other factors leading to lower clinic attendance and treatment failure despite existing interventions.
Financial incentives have emerged as a promising intervention for addressing social determinants of health potentially mitigating internalized HIV stigma by increasing autonomy and enhancing health promoting behaviors; drivers to conforming to social norms including health care and social support seeking behaviors which contribute to averting internalized HIV stigma.
Methods
We conducted a secondary analysis of a cluster randomized controlled from May 2021 to March 2023 across 32 Care and Treatment Centers (CTCs) with new ART initiates randomized 1:1 to receive 22,500 Tsh (~10 USD) conditional on clinic attendance for up to six months in addition to standard of care services or to the standard of care group. Using Chi square and Generalized Linear Model, we examined the effect of an intervention on stigma and change of stigma with time in the two groups using the validated HIV/AIDS Stigma Instrument for People Living with HIV/AIDS (HASI-P) at six and twelve months since ART initiation.
Results
Overall, 1795 study participants were balanced in the two study arms with the intervention arm having 983 (54.76%) participants, median [IQR] age of 35 [27-43] and more than half 1081 (60.22%) being females. Internalized HIV stigma prevalence varied within the two arms each achieving a more than 10% stigma decrease at 12 months. Chi square values of 32.79 with a P-value <0.001 and 51.81 with a P-value <0.001 in the control and intervention groups respectively, indicate significant change in stigma at 6 and 12 months and the intervention arm being superior with a significant adjusted coefficient (ACOEF) of -0.44 (95% CI: -0.64 – -0.23, < 0.001) (GLM) confirming a significant impact in the intervention arm at 12 months.
Conclusions
Internalized HIV stigma is still prevalent even in the presence of an intervention but decreasing with time calling for a multidimensional approach to address internalized HIV stigma including other forms of stigma e.g. external stigma. Cash transfer interventions for internalized HIV stigma should be used with intention to effect long term internalized HIV stigma reduction, a call for further studies evaluating the impact beyond the 12 months mark.
Keywords: Internalized HIV stigma, cash transfers, care outcomes