Pilot Study of an Arts and Theatre-Based HIV Prevention Intervention for Sexual and Gender Minority Migrants in South Africa: Acceptability, Feasibility, and Preliminary Efficacy

BACKGROUND AND PURPOSE

Despite facing high risk of HIV infection, sexual and gender minority (SGM) migrants in South Africa are underserved in the continuum of HIV prevention and care. Efforts to address HIV prevention needs salient in this population are urgently needed. Interventions utilizing visual and narrative techniques are uniquely positioned to not only empower affected individuals to convey stories in their own modes of expression and communication, but also serve as avenues of learning and motivation-building for the audience. We sought to develop and assess the acceptability, feasibility, and preliminary efficacy of Externalize and Mobilize!, an arts and theatre-based HIV prevention intervention for SGM migrants in Cape Town.

METHODS

We collaborated with a community-based organization (CBO) serving diverse SGM individuals in Cape Town on the development of the Externalize and Mobilize! intervention. The first phase of the intervention focused on enhancing HIV-related knowledge and raising awareness of barriers to HIV prevention and care reinforced through intersectional minority stress (related to being a migrant, ethnic minority, and SGM). The second phase entailed developing visual and performance arts that drew on theories of syndemics and constructivism and techniques from Theatre of the Oppressed and Playback Theatre; this culminated in an art exhibition and an immersive theatre performance. The intervention consisted of 4 group sessions that were delivered by researchers and CBO staff together over four days. Participants were recruited and screened at the CBO, and administered pre- and post-intervention assessments of HIV knowledge, HIV risk reduction self-efficacy, stigma, resilience, and intervention acceptability using previously published questionnaires. We conducted paired samples t-tests to examine changes in preliminary efficacy outcomes between pre- and post-intervention. We used open-ended questions to solicit participant perceptions of learning and growth from completing the intervention.

RESULTS

Fourteen participants—identifying as cisgender man who has sex with men (n=7), queer or non-binary (n=4), and transgender woman (n=3)—completed the intervention. Ratings for the intervention demonstrated high acceptability (median=4 out 4 on all 17 items) among participants. Additionally, participants reported significant increases in the scores for HIV knowledge (M=9.5, SD=1.2 vs. M=10.4, SD=0.9, p<.05) and HIV risk-reduction self-efficacy (M=19.9, SD=3.0 vs. M=22.4, SD=2.7, p<.05) between pre- and post-intervention. They also reported a decrease in the self-reported sense of stigma (M=19.0, SD=5.4 vs. M=17.9, SD=5.3, p=.21) and an increase in the self-reported sense of resilience (M=56.8, SD=16.5 vs. M=58.3, SD=11.6, p=.68); these changes were not statistically significant. Inductive analysis of responses to open-ended questions revealed four themes: confidence, HIV knowledge, awareness of rights as an SGM migrant, and self-expression through arts and theatre.

CONCLUSIONS AND IMPLICATIONS

Findings indicate that the Externalize and Mobilize! intervention is highly acceptable and feasible among SGM migrants in South Africa, and can be easily adapted in community settings. We found preliminary evidence for efficacy in increasing HIV knowledge and HIV risk reduction self-efficacy. Findings further support the use of culturally-informed and innovative methods (i.e., arts- and theatre-based exercises) for developing HIV prevention interventions in South Africa that target overlook groups in order to reduce HIV-related disparities.