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  • Batey et al. - Piloting of the FRESH Workshop

    Abstract

    HIV-related stigma has been shown to have profound effects on people living with HIV (PLWH). When stigma is experienced in a healthcare setting, negative health outcomes are exacerbated. We sought to assess the feasibility and acceptability of a healthcare setting stigma-reduction intervention, the Finding Respect and Ending Stigma around HIV (FRESH) Workshop, in the United States. This intervention, adapted from a similar strategy implemented in Africa, brought together healthcare workers (HW) and PLWH to address HIV-related stigma. Two pilot workshops were conducted in Alabama and included 17 HW and 19 PLWH. Participants completed questionnaire measures pre- and post-workshop, including open-ended feedback items. Analytical methods included assessment of measures reliability, pre–post-test comparisons using paired t-tests, and qualitative content analysis. Overall satisfaction with the workshop experience was high, with 87% PLWH and 89% HW rating the workshop “excellent” and the majority agreeing that others like themselves would be interested in participating. Content analysis of open-ended items revealed that participants considered the workshop informative, interactive, well-organized, understandable, fun, and inclusive, while addressing real and prevalent issues. Most pre- and post-test measures had good–excellent internal consistency reliability (Cronbach's alphas ranging from 0.70 to 0.96) and, although sample sizes were small, positive trends were observed, reaching statistical significance for increased awareness of stigma in the health facility among HW (p = 0.047) and decreased uncertainty about HIV treatment among PLWH (p = 0.017). The FRESH intervention appears to be feasible and highly acceptable to HW and PLWH participants and shows great promise as a healthcare setting stigma-reduction intervention for US contexts.
    Batey DS, Whitfield S, Mulla M, Stringer KL, Durojaiye M, McCormick L, Turan B, Nyblade L, Kempf MC, Turan JM. Adaptation and Implementation of an Intervention to Reduce HIV-Related Stigma Among Healthcare Workers in the United States: Piloting of the FRESH Workshop. AIDS Patient Care STDS. 2016 Nov;30(11):519-527. doi: 10.1089/apc.2016.0223. PMID: 27849373; PMCID: PMC5116658.

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  • Budhwani et al. - Adapting and pilot testing an HIV and intersectional stigma reducing intervention for Dominican Republic healthcare contexts

    Budhwani H, Paulino-Ramírez R, Waters J, Bond CL, Ruiz I, Long DM, Varas-Díaz N, Naar S, Nyblade L, Turan JM. Adapting and pilot testing an HIV and intersectional stigma reducing intervention for Dominican Republic healthcare contexts: Protocol for translational research. Contemp Clin Trials Commun. 2022 Aug 19;29:100980. doi: 10.1016/j.conctc.2022.100980. PMID: 36060154; PMCID: PMC9434029.

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  • Conserve et al. - Adapting a community-based intervention to address social determinants of health influencing pre-exposure prophylaxis services for Black adults in Washington, District of Columbia

    Conserve DF, Tun W, Hickson DA, Gomez-Berrospi J, Janson S, Rinola B, Durkin M, Buchanan C, Morris C, Saleeban A, Olughu K, Pulerwitz J, Kerrigan D. Adapting a community-based intervention to address social determinants of health influencing pre-exposure prophylaxis services for Black adults in Washington, District of Columbia: A study protocol. PLoS One. 2023 Nov 3;18(11):e0290631. doi: 10.1371/journal.pone.0290631. PMID: 37922262; PMCID: PMC10624286.

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  • Crockett et al. - Patient and Provider Perspectives on HIV Stigma in Healthcare Settings in Underserved Areas of the US South: A Mixed Methods Study

    Abstract

    Stigma experienced in healthcare settings is a barrier to ending the HIV epidemic. Using a convergent parallel mixed methods approach, we collected qualitative data from 14 focus groups with People with HIV (PWH) and Healthcare workers (HCW) and quantitative survey data (N = 762 PWH and N = 192 HCW) from seven HIV healthcare clinics outside of major urban areas in the southeastern US. Four key themes emerged: (1) HIV-related stigma and discrimination in healthcare settings; (2) experiences of intersectional stigma; (3) disclosure concerns in healthcare settings; and (4) impact of stigma on HIV-related health behavior. Implications for future stigma interventions in healthcare settings include the importance of engaging PWH in the development of interventions, the need for interventions in settings that do not specialize in HIV care, and the importance of engaging all staff when addressing HIV-related stigma.

    Crockett KB, Turan B, Whitfield S, Kay ES, Budhwani H, Fifolt M, Hauenstein K, Ladner MD, Sewell J, Payne-Foster P, Nyblade L, Batey DS, Turan JM. Patient and Provider Perspectives on HIV Stigma in Healthcare Settings in Underserved Areas of the US South: A Mixed Methods Study. AIDS Behav. 2022 Jan;26(Suppl 1):112-124. doi: 10.1007/s10461-021-03470-y. Epub 2021 Sep 28. PMID: 34581951; PMCID: PMC9009188.

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  • Chibanda et al. - Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe

    Chibanda D, Verhey R, Munetsi E, Cowan FM, Lund C. Using a theory driven approach to develop and evaluate a complex mental health intervention: the friendship bench project in Zimbabwe. Int J Ment Health Syst. 2016 Feb 29;10:16. doi: 10.1186/s13033-016-0050-1. PMID: 26933448; PMCID: PMC4772526.

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  • Rosenberg - Depressed? Here’s a Bench. Talk to Me.

    Rosenberg, T. (2019). Depressed? here’s a bench. talk to me. New York Times. Retrieved 2025, from https://www.nytimes.com/2019/07/22/opinion/depressed-heres-a-bench-talk-to-me.html.

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  • Daniel et al. - Harambee! 2.0: The Impact of HIV‑Related and Intersectional Stigmas on HIV Testing Behaviors Among African Immigrant Communities in Seattle, Washington

    Abstract

    African immigrants are disproportionately affected by HIV compared to U.S.-born individuals, and early HIV testing is the key challenge in ending the HIV epidemic in these communities. HIV-related stigma appears to be the most significant barrier to testing for HIV among African communities in King County, WA. In this formative study, we conducted thirty key informant interviews and five focus group discussions (n = total 72 participants) with Ethiopian, Somali, and Eritrean people living with HIV, health professionals, religious and other community leaders, and lay community members in King County to better understand HIV-related and intersectional stigmas’ impact on HIV testing behaviors. We used inductive coding and thematic analysis. Participants from all communities reported similar themes for HIV-related and intersectional stigmas’ influences on HIV testing behaviors. Misconceptions or poor messaging, e.g., regarding treatability of HIV, as well as normative or religious/moral beliefs around pre/extramarital sex contributed to HIV-related stigma. Intersecting identities such as immigrant status, race/ethnicity, and having a non-English language preference, all intermingle to further influence access to the U.S. healthcare system, including for HIV testing. These findings can be used to inform future research on community-led approaches to addressing early HIV testing amongst African immigrant communities.

    Daniel NA, Hassan SA, Mohamed F, Sheikh N, Basualdo G, Schwartz R, Gebreselassie BT, Beyene YK, Gabreselassie L, Bayru K, Tadesse B, Libneh HA, Shidane M, Benalfew S, Ali A, Rao D, Kerani RP, Patel RC. Harambee! 2.0: The Impact of HIV-Related and Intersectional Stigmas on HIV Testing Behaviors Among African Immigrant Communities in Seattle, Washington. AIDS Behav. 2022 Jan;26(Suppl 1):149-164. doi: 10.1007/s10461-021-03396-5. Epub 2021 Aug 9. PMID: 34368910; PMCID: PMC8349708.

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  • Roberts et al. - Harambee!: A pilot mixed methods study of integrated residential HIV testing among African-born individuals in the Seattle area

    Roberts DA, Kerani R, Tsegaselassie S, Abera S, Lynes A, Scott E, Chung K, Yohannes E, Basualdo G, Stekler JD, Barnabas R, James J, Cooper-Ashford S, Patel R. Harambee!: A pilot mixed methods study of integrated residential HIV testing among African-born individuals in the Seattle area. PLoS One. 2019 May 6;14(5):e0216502. doi: 10.1371/journal.pone.0216502. PMID: 31059553; PMCID: PMC6502314.

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  • Hassan et al. - Qualitative Insights from Harambee! 2.0

    Hassan, S.A.; Mohamed, F.; Sheikh, N.; Basualdo, G.; Daniel, N.A.; Schwartz, R.; Gebreselassie, B.T.; Beyene, Y.K.; Gabreselassie, L.; Bayru, K.; et al. “They Wait until the Disease Has Taking over You and the Doctors Cannot Do Anything about It”: Qualitative Insights from Harambee! 2.0. Int. J. Environ. Res. Public Health 2021, 18, 12706. https://doi.org/10.3390/ijerph182312706

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  • Hassan et al. - When Culture and Preventative Care Collide

    Hassan, S., Mohamed, F., Patel, R., & Kerani, R. (2024, July 19). When culture and preventative care collide. Public Health Post. https://publichealthpost.org/health-equity/culture-preventative-care-collide/

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  • Felton et al. - Peer Activate: A Feasibility Trial of a Peer-Delivered Intervention to Decrease Disparities in Substance Use, Depression, and Linkage to Substance Use Treatment

    Abstract

    Although effective evidence-based interventions (EBIs) exist, racial/ethnic minority individuals with lower income are less likely to have access to these interventions and may experience greater stigma in the health care system, resulting in disproportionate rates of morbidity and mortality. Peer recovery specialists (PRSs) may be uniquely suited to address barriers faced by those from impoverished areas; however, peers have not traditionally been trained in implementing EBIs. The current open-label trial (N = 8) was performed to evaluate implementation and preliminary effectiveness of an adapted EBI supporting recovery, linkage to treatment, and reduced depression. Results suggest the intervention was feasible, acceptable, and appropriate for linking individuals from a community setting to substance use treatment and could be delivered with fidelity by a peer interventionist. Participants who completed the intervention demonstrated clinically reliable decreases in substance use and depressive symptoms. Findings provide initial support for PRS dissemination of EBIs to increase linkage to care and support recovery in traditionally underserved populations.

    Felton JW, Kleinman MB, Doran K, Satinsky EN, Tralka H, Dean D, Brown CJS, Anvari MS, Bradley VD, Magidson JF. Peer Activate: A Feasibility Trial of a Peer-Delivered Intervention to Decrease Disparities in Substance Use, Depression, and Linkage to Substance Use Treatment. J Psychosoc Nurs Ment Health Serv. 2023 Nov;61(11):23-31. doi: 10.3928/02793695-20230523-02. Epub 2023 Jun 2. PMID: 37256749.

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  • Guisto et al. - Global Is Local: Leveraging Global Mental-Health Methods

    Abstract

    Structural barriers perpetuate mental health disparities for minoritized US populations; global mental health (GMH) takes an interdisciplinary approach to increasing mental health care access and relevance. Mutual capacity building partnerships between low and middle-income countries and high-income countries are beginning to use GMH strategies to address disparities across contexts. We highlight these partnerships and shared GMH strategies through a case series of said partnerships between Kenya-North Carolina, South Africa-Maryland, and Mozambique-New York. We analyzed case materials and narrative descriptions using document review. Shared strategies across cases included: qualitative formative work and partnership-building; selecting and adapting evidence-based interventions; prioritizing accessible, feasible delivery; task-sharing; tailoring training and supervision; and mixed-method, hybrid designs. Bidirectional learning between partners improved the use of strategies in both settings. Integrating GMH strategies into clinical science-and facilitating learning across settings-can improve efforts to expand care in ways that consider culture, context, and systems in low-resource settings.

    Giusto A, Jack HE, Magidson JF, Ayuku D, Johnson S, Lovero K, Hankerson SH, Sweetland AC, Myers B, Fortunato Dos Santos P, Puffer ES, Wainberg ML. Global Is Local: Leveraging Global Mental-Health Methods to Promote Equity and Address Disparities in the United States. Clin Psychol Sci. 2024 Mar;12(2):270-289. doi: 10.1177/21677026221125715. Epub 2023 Jan 10. PMID: 38529071; PMCID: PMC10962902.

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  • Kane et al. - Efficacy of the Common Elements Treatment Approach (CETA) for Unhealthy Alcohol Use Among Adults with HIV in Zambia

    Abstract

    This randomized controlled trial tested the efficacy of a multi-session, evidence-based, lay counselor-delivered transdiagnostic therapy, the Common Elements Treatment Approach (CETA), in reducing unhealthy alcohol use and comorbidities among persons living with HIV (PLWH) in Zambia. Adult PLWH with (a) unhealthy alcohol use plus mental health or substance use comorbidities, or (b) severe unhealthy alcohol use were randomized to receive a single-session alcohol brief intervention (BI) alone or BI plus referral to CETA. Outcomes were measured at baseline and a 6-month follow-up and included Alcohol Use Disorders Identification Test (AUDIT) score (primary), depression and trauma symptoms, and other substance use (secondary). We enrolled 160 participants; 78 were randomized to BI alone and 82 to BI plus CETA. Due to COVID-19, the trial ended early before 36 participants completed. Statistically and clinically significant reductions in mean AUDIT score from baseline to 6-month follow-up were observed in both groups, however, participants assigned to BI plus CETA had significantly greater reductions compared to BI alone (- 3.2, 95% CI - 6.2 to - 0.1; Cohen's d: 0.48). The CETA effect size for AUDIT score increased in line with increasing mental health/substance use comorbidity (0 comorbidities d = 0.25; 1-2 comorbidities d = 0.36; 3+ comorbidities d = 1.6). Significant CETA treatment effects were observed for depression, trauma, and several other substances. BI plus referral to CETA was feasible and superior to BI alone for unhealthy alcohol use among adults with HIV, particularly among those with comorbidities. Findings support future effectiveness testing of CETA for HIV outcomes among PLWH with unhealthy alcohol use.Clinical Trials Number: NCT03966885.

    Kane JC, Sharma A, Murray LK, Chander G, Kanguya T, Skavenski S, Chitambi C, Lasater ME, Paul R, Cropsey K, Inoue S, Bosomprah S, Danielson CK, Chipungu J, Simenda F, Vinikoor MJ. Efficacy of the Common Elements Treatment Approach (CETA) for Unhealthy Alcohol Use Among Adults with HIV in Zambia: Results from a Pilot Randomized Controlled Trial. AIDS Behav. 2022 Feb;26(2):523-536. doi: 10.1007/s10461-021-03408-4. Epub 2021 Jul 30. PMID: 34328570; PMCID: PMC8322829.

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  • Magidson et al. - Project Khanya: results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa

    Magidson JF, Joska JA, Belus JM, Andersen LS, Regenauer KS, Rose AL, Myers B, Majokweni S, O'Cleirigh C, Safren SA. Project Khanya: results from a pilot randomized type 1 hybrid effectiveness-implementation trial of a peer-delivered behavioural intervention for ART adherence and substance use in HIV care in South Africa. J Int AIDS Soc. 2021 Jun;24 Suppl 2(Suppl 2):e25720. doi: 10.1002/jia2.25720. PMID: 34164935; PMCID: PMC8222840.

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  • Miller - Mental health gets a boost in Texas

    Miller, J. (2021). Mental health gets a boost in Texas | Harvard Medical School. News & Research. https://hms.harvard.edu/news/mental-health-gets-boost-texas

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  • Humphreys - Vikram Patel: Fresh ways of delivering mental health care

    Humphreys G. Vikram Patel: fresh ways of delivering mental health care. Bull World Health Org. 2023 May 1;101(05):305–6.

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  • Patel et al. - EMPOWER: Toward the Global Dissemination of Psychosocial Interventions

    Abstract

    Even before the COVID-19 pandemic, the needs for care of persons with mental illness remained largely unmet worldwide, testifying to the inadequacy of current approaches to mental health care and their unsuitability for the rising demand. One hurdle to improved access to quality care is the reliance on expensive specialist providers, particularly for the delivery of psychosocial interventions. This article describes EMPOWER, a not-for-profit program that builds on the clinical science demonstrating the effectiveness of brief psychosocial interventions for a range of psychiatric conditions; implementation science demonstrating the effectiveness of delivery of these interventions by non-specialist providers (NSPs); and pedagogical science demonstrating the effectiveness of digital approaches for training and quality assurance. The EMPOWER program leverages digital tools for training and supervising NSPs, designing competency-based curricula, assessing treatment-specific competencies, implementing measurement-based peer supervision for support and quality assurance, and evaluating impacts to enhance the effectiveness of the delivery system.

    Patel V, Naslund JA, Wood S, Patel A, Chauvin JJ, Agrawal R, Bhan A, Joshi U, Amara M, Kohrt BA, Singla DR, Fairburn CG. EMPOWER: Toward the Global Dissemination of Psychosocial Interventions. Focus (Am Psychiatr Publ). 2022 Summer;20(3):301-306. doi: 10.1176/appi.focus.20220042. Epub 2022 Jun 22. PMID: 37021040; PMCID: PMC10071408.

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  • Puffer et al. - Family Strengthening in the Context of COVID‑19: Adapting a Community‑Based Intervention from Kenya to the United States

    Puffer ES, Johnson SL, Quick KN, Rieder AD, Mansoor M, Proeschold-Bell RJ, Jones S, Moore-Lawrence S, Rasmussen JD, Cucuzzella C, Burwell F, Dowdy L, Moore F, Rosales N, Sanyal A, Ramachandran P, Duerr E, Tice L, Ayuku D, Boone WJ. Family Strengthening in the Context of COVID-19: Adapting a Community-Based Intervention from Kenya to the United States. Prev Sci. 2024 Feb;25(2):267-278. doi: 10.1007/s11121-022-01418-9. Epub 2022 Aug 30. PMID: 36040621; PMCID: PMC9425799.

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  • Rao et al. - Feasibility, Acceptability, and Preliminary Efficacy of the Unity Workshop

    Rao D, Desmond M, Andrasik M, Rasberry T, Lambert N, Cohn SE, Simoni J. Feasibility, acceptability, and preliminary efficacy of the unity workshop: an internalized stigma reduction intervention for African American women living with HIV. AIDS Patient Care STDS. 2012 Oct;26(10):614-20. doi: 10.1089/apc.2012.0106. Epub 2012 Sep 17. PMID: 22984780; PMCID: PMC3462391.

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  • Rao et al. - Stigma Reduction Among African American Women With HIV: UNITY Health Study

    Abstract

    Introduction: African American women encounter disproportionately high rates of HIV-related morbidity and mortality, which is partially mediated through stigma and its effect on HIV treatment adherence.

    Objective: To assess the effect of the UNITY peer support workshop on HIV-related stigma among African American women living with HIV, compared with a time and attention control group.

    Methods: African American women living with HIV were randomized to the UNITY workshop or a breast cancer education control group. Interventions took place in HIV clinics in Chicago, IL and Birmingham, AL. Participants self-reported HIV-related stigma and social support at baseline, after workshop, and at 4 follow-up visits over 12 months.

    Results: Two hundred thirty-nine participants (UNITY n = 124; breast cancer education n = 115) were assessed over 1 year. Both arms experienced decreases in mean stigma scores over time. Our model estimated that allocation to UNITY was not associated with a significant difference in stigma points over time. Post hoc analysis suggested that preceding increases in perceived social support are associated with decreased HIV-related stigma in this population.

    Conclusions: Although UNITY did not significantly reduce HIV-related stigma in this population, our findings suggest that social support may be key to HIV-related stigma reduction.

    Rao D, Kemp CG, Huh D, Nevin PE, Turan J, Cohn SE, Simoni JM, Andrasik M, Molina Y, Mugavero MJ, French AL. Stigma Reduction Among African American Women With HIV: UNITY Health Study. J Acquir Immune Defic Syndr. 2018 Jul 1;78(3):269-275. doi: 10.1097/QAI.0000000000001673. PMID: 29528941; PMCID: PMC5997522.

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  • Stockton et al. - The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi

    Stockton MA, Udedi M, Kulisewa K, Hosseinipour MC, Gaynes BN, Mphonda SM, Maselko J, Pettifor AE, Verhey R, Chibanda D, Lapidos-Salaiz I, Pence BW. The impact of an integrated depression and HIV treatment program on mental health and HIV care outcomes among people newly initiating antiretroviral therapy in Malawi. PLoS One. 2020 May 6;15(5):e0231872. doi: 10.1371/journal.pone.0231872. PMID: 32374724; PMCID: PMC7202614.

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  • Uys et al. - Evaluation of a Health Setting-Based Stigma Intervention in Five African Countries

    Uys L, Chirwa M, Kohi T, Greeff M, Naidoo J, Makoae L, Dlamini P, Durrheim K, Cuca Y, Holzemer WL. Evaluation of a health setting-based stigma intervention in five African countries. AIDS Patient Care STDS. 2009 Dec;23(12):1059-66. doi: 10.1089/apc.2009.0085. PMID: 20025515; PMCID: PMC2832642.

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Acknowledge the Center

Support the UAB Center for AIDS Research by acknowledging services in publications, abstracts, and grants. Cite us: This research was supported by the University of Alabama at Birmingham (UAB) Center For AIDS Research CFAR, an NIH funded program (P30 AI027767) that was made possible by the following institutes: NIAID, NCI, NICHD, NHLBI, NIDA, NIMH, NIA, NIDDK, NIGMS, NIMHD, FIC, NIDCR, and OAR.