HIV Stigma Reduction Interventions: A Systematic Review of the Evidence

Background: Adolescents living with HIV face numerous challenges including stigma, negative attitudes, and discrimination. These challenges have detrimental effects on psychological well-being and social interactions resulting in increased levels of depression and social exclusion. Adolescents in Sub-Saharan Africa bear the heaviest burden of HIV globally with high rates of infection. Previous systematic reviews have been conducted to examine stigma reduction interventions, however, were not focused solely on adolescents. To increase our understanding of stigma reduction interventions in this population the following research questions were addressed: 1) What types of interventions and outcomes have been conducted to reduce HIV stigma? 2) What is the methodological rigor of these studies? 3) What types of interventions are most effective in reducing HIV stigma-related outcomes considering methodological rigor of the studies?

Methods: A systematic research of 5 databases was conducted to identify studies published between 2014 to 2024 based on a UNAIDS report (2014) highlighting the urgency of addressing HIV-related stigma. The inclusion criteria for this review were: a) published in English, b) conducted in Sub-Sahara Africa, c) adolescents and young adults aged 12-24, d) interventions designed to reduce HIV-stigma, e) experimental, quasi-experimental, pre-post designs, g) included stigma-related outcomes. The 12-item Methodological Quality Rating Scale assessed study rigor, with possible total scores ranging from 0 to 14. Studies that scored equal to or above the median were considered to have higher rigor and those below the median were considered lower rigor. Evidence of the effectiveness of each study’s intervention was rated “strong” if the methodological rigor rated high and the outcome was significant, “promising” if the methodological rigor rated lower and the outcome was significant, and “weak” if the rigor was rated either high or low and the outcome was not significant.

Results: Thirteen studies met the inclusion criteria for this review, with eight health facility-based intervention studies and five non-health facility intervention studies (e.g., conducted at campgrounds, community open spaces, schools). The most common outcomes were: stigma (n=10), and depression (n=7). Results of MQRS showed 54% (n=7) of the studies showing high methodological rigor and 46% (n=6) showing low rigor based on the median split of 10 with a mean of 9.53 and range 5-12. The methodological strengths were: study designs, intervention integrity, and participants’ follow-up. Weaknesses were: lack of theoretically-based interventions, measurement reliability and validity. Of health facility based interventions 4 out of 8 demonstrated strong evidence for effectiveness in reducing HIV stigma (significant outcomes and high rigor), 2 demonstrated promising evidence, and 2 showed weak evidence. Of the non-health facility based interventions, both of the 2 studies demonstrated strong evidence for reducing stigma; for depression, both health and non-health facility interventions showed significant results.

Conclusion: The findings reveal that for non-health facility based interventions the evidence was slightly stronger in reducing stigma. For depression, the evidence for both intervention types was equally effective. Future research may be needed to compare the acceptability and preferences of adolescents for receiving HIV-related stigma interventions in both health and non-health settings.