Self-stigma; negative self-judgement resulting in shame, worthlessness and blame represents an important but neglected aspect of living with HIV. It impacts a person's ability to live positively, limits meaningful self agency, quality of life, adherence to treatment and access to health services. Although high levels have been reported through the People Living with HIV Stigma Index, few interventions exist to specifically tackle this issue; particularly interventions that provide PLHIV with skills to address self stigma in peer-support groups, in resource poor settings. Recognising the prevalence of self-stigma and the absence of a dedicated strategy to address it, the decision was taken to pilot an intervention within the HIV programme in Zimbabwe. The intervention uses a methodology called Inquiry Based Stress Reduction (IBSR) and is based on the work of Byron Katie (thework.com) and was implemented in partnership with ZNNP+ and 23 of its members.
The programme
Trócaire and ZNNP+ designed, implemented and evaluated a 12-week pilot programme using IBSR. Based on formative research, a curriculum was designed to support participants to work through self-stigmatising beliefs (self-abasement, shame, guilt, disclosure, restricted agency, hopelessness, sexuality and death). Two ZNNP+ facilitators worked with internationally certified facilitators to deliver the programme with two groups of 11 participants. Qualitative and quantitative data was collected at baseline, post-programme and at three months follow up. The Internalised-AIDS Stigma Scale and the Quality of Life (QoL) scale measuring mood, perceived stress and quality of life were used. For evaluation purposes it was designed as an operations research study with the support of Royal College of Surgeons in Ireland (RCSI). Ethics approval was secured from the Medical Research Council of Zimbabwe (MRCZ) with a local research institution Impact Research International (IPI) as principle investigator.
Findings
'I used to feel that I was unequal to other people but now I feel that I am just as good as anyone else'.
Results at three month follow up show really positive impacts. Qualitatively, participants report profound shifts in their lives - around living positively with HIV, lessened fears about disclosure, not feeling limited by HIV, and increased peacefulness. Quantitatively, results show statistically significant improvements in a number of areas (% improved): self-stigma (61%), depression (78%), life satisfaction (52%), fears around disclosure (52%) and daily activity (70%). The findings will be published in a peer reviewed article in the late summer/autumn and hopefully also in a Zimbabwean/ Southern African journal.
trocaire.ie/
znnp.org.zw/
thework.com
For more information contact Nadine Ferris France: nadinefrance@gmail.com
Created by: Elena Hermosa
