Proscovia Nabunya, MSW, PhD, Associate Professor, Washington University in Saint Louis, St. Louis, MO
Francis Matovu, BA, Study Coordinator, International Center for Child Health and Development (ICHAD), Masaka, Uganda
Samuel Kizito, MD, PhD, Research Assistant Professor, New York University, New York, NY
Madrine Nakisekka, BA, Study Coordinator, International Center for Child Health and Development, Masaka, Uganda
Ivan Bukeddeko Musisi, BA, Data Manager, International Center for Child Health and Development, Masaka, Uganda
Abel Zemedkun Girma, MPH, Data and Study Coordinator, Washington University in Saint Louis, St. Louis, MO
Samiri Jamiru, MS, Lab Manager/Study Coordinator, International Center for Child Health and Development, Uganda
Anita Kabarambi, MD, Doctoral Student, Washington University in Saint Louis, St. Louis, MO
Fred M Ssewamala, PhD, Professor, New York University, New York, NY
Background: HIV stigma remains a major barrier to all aspects of the HIV care continuum and a critical threat to health equity and participation in public health. It has been associated with decreased HIV testing and prevention efforts (including condom use and pre-exposure prophylaxis) uptake), linkage to and retention in care, and medication adherence among those living with HIV. Although interventions to reduce stigma have shown promise globally, evidence from Sub-Saharan Africa, particularly among adolescents living with HIV (ALHIV) remains limited. Economic strengthening (ES) strategies may reduce stigma by altering perceptions linking HIV to morbidity and mortality, thereby promoting social inclusion and the right of all adolescents to full participation in their communities. However, the majority of studies have mainly focused on the role of ES on HIV prevention and treatment outcomes. This study evaluated the long-term impact of a family-based ES intervention on HIV stigma among ALHIV in Uganda. We hypothesized that over time, adolescents receiving ES would report a decline in HIV stigma compared to those in the control condition.
Methods: We analyzed longitudinal data (2012-2025) from a two-arm cluster randomized clinical trial evaluating a family-based ES intervention among ALHIV. The study recruited 702 ALHIV from 39 health clinics in southern Uganda. Adolescents were eligible to participate if they were (1) aged 10 to 16 years at enrollment; (2) living with HIV and aware of their HIV status; (3) living within a family setting; (4) enrolled on antiretroviral therapy treatment. The intervention comprised matched savings account, financial literacy training, and microenterprise workshops. Mixed-effects regression models were used to estimate intervention effects over time.
Results: The average participants age at enrollment was 12 years. Adolescents receiving the ES intervention experienced greater reductions in HIV stigma across the study period. Specifically, mixed-effects regression analyses revealed a significant overall effect of the intervention on HIV stigma (group omnibus test: χ²=5.77, df=1, p=0.016). There was also a significant group × time interaction (χ²=17.97, df=8, p=0.022), indicating that changes in HIV stigma over time differed between the intervention and control groups.
Conclusion and Implication: Family-based ES holds promise as a rigorous, evidence-based approach to HIV stigma reduction among adolescents in resource-limited settings. Integrating ES within existing HIV treatment and care strategies may enhance psychosocial outcomes, reduce HIV stigma, and improve treatment outcomes.
![[ Visit Client Website ]](images/banner.gif)