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Lumding Railway Colony, India

Stangl A.L.,International Center for Research on Women
Journal of the International AIDS Society

HIV-related stigma and discrimination continue to hamper efforts to prevent new infections and engage people in HIV treatment, care and support programmes. The identification of effective interventions to reduce stigma and discrimination that can be integrated into national responses is crucial to the success of the global AIDS response. We conducted a systematic review of studies and reports that assessed the effectiveness of interventions to reduce HIV stigma and discrimination between 1 January 2002 and 1 March 2013. Databases searched for peer-reviewed articles included PubMed, Scopus, EBSCO Host -CINAHL Plus, Psycinfo, Ovid, Sociofile and Popline. Reports were obtained from the www.HIVAIDSClearinghouse.eu, USAID Development Experience Clearinghouse, UNESCO HIV and AIDS Education Clearinghouse, Google, WHO and UNAIDS. Ancestry searches for articles included in the systematic review were also conducted. Studies of any design that sought to reduce stigma as a primary or secondary objective and included pre- and post-intervention measures of stigma were included. Of 2368 peer-reviewed articles and reports identified, 48 were included in our review representing 14 different target populations in 28 countries. The majority of interventions utilized two or more strategies to reduce stigma and discrimination, and ten included structural or biomedical components. However, most interventions targeted a single socio-ecological level and a single domain of stigma. Outcome measures lacked uniformity and validity, making both interpretation and comparison of study results difficult. While the majority of studies were effective at reducing the aspects of stigma they measured, none assessed the influence of stigma or discrimination reduction on HIV-related health outcomes. Our review revealed considerable progress in the stigma-reduction field. However, critical challenges and gaps remain which are impeding the identification of effective stigma-reduction strategies that can be implemented by national governments on a larger scale. The development, validation, and consistent use of globally relevant scales of stigma and discrimination are a critical next step for advancing the field of research in this area. Studies comparing the effectiveness of different stigma-reduction strategies and studies assessing the influence of stigma reduction on key behavioural and biomedical outcomes are also needed to maximize biomedical prevention efforts. Source

Pelto P.J.,Independent Consultant | Singh R.,International Center for Research on Women
AIDS and Behavior

This paper presents data on the role and implementation of street theatre as a communications technique for HIV behavioral interventions in low income slum communities in Mumbai. Second, we situate the uses of street theatre as a social intervention strategy within a long history of outdoor drama as entertainment and social action in India. Street theatre with accompanying activities was a central element of the RISHTA project's communications strategy in communities in Mumbai, designed to deliver tailored risk reduction messages to married men who were involved in extramarital relationships. The paper presents examples of the contents and delivery of alcohol risk reduction messages through street plays that were developed and performed by actors from low income communities. The paper situates street plays as part of the domain of prevention strategies, which can be effective in reducing HIV risks, including those related to alcohol use. © Springer Science+Business Media, LLC 2010. Source

Schensul S.L.,University of Connecticut Health Center | Singh R.,International Center for Research on Women
AIDS and Behavior

This paper examines the relationship of frequency, type of alcohol use, sexual risk behaviors and sexually transmitted infections (STIs) among married men living in economically marginal communities in Mumbai, India. The findings indicate that men who consume alcohol daily were four times more likely to have had extramarital sex in the past 12 months. In terms of sexually transmitted infections, men who were daily drinkers were four times more likely than those not consuming alcohol in the last month to have gonorrhea (NG) and Chlamydia (CT) infection and three times more likely to have had a past history of exposure to herpes simplex virus-2 (HSV-2) and/ or syphilis as determined by biological testing. These results demonstrate that men with daily alcohol use are at greatest risk for STIs and need to be targeted for community outreach, de-addiction services and sex risk reduction education program in India and elsewhere. © Springer Science+Business Media, LLC 2010. Source

Speizer I.S.,University of North Carolina at Chapel Hill | Calhoun L.M.,University of North Carolina at Chapel Hill | Hoke T.,FHI 360 | Sengupta R.,International Center for Research on Women

Background The measure of unmet need relies on women's reported fertility desires; previous research has demonstrated that fertility desires may be fluid and not firm. Study Design Our study uses recently collected longitudinal data from four cities in Uttar Pradesh, India, to examine whether women's fertility desires and family planning (FP) use at baseline predict pregnancy/birth experience in the 2-year follow-up period. Results Multivariate models demonstrate that women who were using any method of FP and reported an intention to stop childbearing were the least likely to experience a pregnancy/birth in the 2-year follow-up period. The stated desire to delay childbearing, whether or not the woman was using FP, did not distinguish pregnancy/birth experience. Ninety-two percent of pregnancies/births over the follow-up period were considered "wanted then" suggesting post-hoc rationalization of the pregnancy/birth even among those women who reported a desire to stop childbearing 2 years earlier. Conclusions More nuanced assessments of fertility intentions may be needed to adequately gauge latent FP needs. Non-users of FP may be ambivalent about future childbearing and the timing of future births; these women may not have an unmet need for FP as typically defined. © 2013 Elsevier Inc. Source

Jain A.,International Center for Research on Women
Journal of the International AIDS Society

HIV stigma and discrimination are major issues affecting people living with HIV in their everyday lives. In Thailand, a project was implemented to address HIV stigma and discrimination within communities with four activities: (1) monthly banking days; (2) HIV campaigns; (3) information, education and communication (IEC) materials and (4) "Funfairs." This study evaluates the effect of project interventions on reducing community-level HIV stigma. A repeated cross-sectional design was developed to measure changes in HIV knowledge and HIV-related stigma domains among community members exposed to the project. Two cross-sectional surveys were implemented at baseline (respondent n=560) and endline (respondent n=560). T-tests were employed to assess changes on three stigma domains: fear of HIV infection through daily activity, shame associated with having HIV and blame towards people with HIV. Baseline scales were confirmed at endline, and each scale was regressed on demographic characteristics, HIV knowledge and exposure to intervention activities. No differences were observed in respondent characteristics at baseline and endline. Significant changes were observed in HIV transmission knowledge, fear of HIV infection and shame associated with having HIV from baseline to endline. Respondents exposed to three specific activities (monthly campaign, Funfair and IEC materials) were less likely to exhibit stigma along the dimensions of fear (3.8 points lower on average compared to respondents exposed to none or only one intervention; 95% CI: -7.3 to -0.3) and shame (4.1 points lower; 95% CI: -7.7 to -0.6), net of demographic controls and baseline levels of stigma. Personally knowing someone with HIV was associated with low fear and shame, and females were less likely to possess attitudes of shame compared to males. The multivariate linear models suggest that a combination of three interventions was critical in shifting community-level stigma--monthly campaign, Funfair and IEC materials. This is especially important given Thailand's new national AIDS strategy to reduce HIV-related stigma and discrimination by half by 2016. Knowing which interventions to invest in for HIV stigma reduction is crucial for country-wide expansion and scale-up of intervention activities. Source

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