Stigma interdependence among pregnant HIV-infected couples in a cluster randomized controlled trial from rural South Africa

J. M. Abbamonte, S. Ramlagan, T. K. Lee, N. V. Cristofari, S. M. Weiss, K. Peltzer, S. Sifunda, D. L. Jones

Research output: Contribution to journalArticle

Abstract

Background: Stigma can exacerbate negative health outcomes in people living with HIV (PLWH). This longitudinal, cluster randomized controlled trial in rural Mpumalanga, South Africa, examined the interdependence of HIV-related stigma among pregnant couples living with HIV, and the potential impact of a lay health worker delivered intervention, Protect Your Family, on changes in stigma over time across couples, controlling for physical intimate partner violence (IPV), verbal IPV, gender, HIV knowledge, and months since HIV diagnosis. Using a form of the Actor-Partner Interdependence model, changes in stigma over time were also examined within each dyad of seroconcordant participants with HIV. Method: Antenatal clinics were randomized to experimental or control conditions, and participants completed baseline antenatal and 12-month postpartum assessments. Both women and male partners participated in intervention sessions in gender concordant groups and couple or individual sessions. Results: Multilevel models (N = 1475) revealed stigma was related to condition and verbal intimate partner violence, but not time. Using an Actor-Partner Interdependence cross-lagged path model to examine within dyad changes in stigma for seroconcordant couples (n = 201), intervention condition participants' stigma levels were not interdependent over time. Women's 12-month stigma was related to their partners' stigma at baseline in the control condition, but not in the intervention condition. Discussion: Compared to women in the control condition, postpartum stigma among women in the intervention condition was not related to their male partners' stigma, suggesting that women's perception of stigma became uncoupled from that of their partners. The intervention may have promoted female empowerment to shape their own beliefs and attitudes towards what it means to be infected with HIV, and express their own agency in responding to how others treat them and they treat themselves.

Original languageEnglish (US)
Article number112940
JournalSocial Science and Medicine
Volume253
DOIs
StatePublished - May 2020

Keywords

  • Couples
  • Dyadic
  • HIV
  • Intervention
  • South Africa
  • Stigma

ASJC Scopus subject areas

  • Health(social science)
  • History and Philosophy of Science

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