Changes in HIV Internalized and Experienced Stigmas and Social Support After an Urban Gardens and Peer Nutritional Counseling Intervention Among People With HIV and Food Insecurity in the Dominican Republic.

Kathryn P Derose, Kartika Palar, Lila A Sheira, Bing Han, Amarilis Then-Paulino, Gabriela Armenta, Alane Celeste-Villalvir, Gipsy Jimenez-Paulino, Ramón Acevedo, Yeycy Donastorg, Hugo Farías, Glenn J Wagner

Journal: Journal of acquired immune deficiency syndromes (1999) 2024;97(1):55-62

PMID: 39116332

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Abstract

BACKGROUND

Food insecurity and HIV-related stigma negatively affect HIV outcomes. Few studies have examined how food security interventions affect HIV-related stigma and social support.

SETTING

Two HIV clinics in the Dominican Republic.

METHODS

A pilot cluster randomized controlled trial of an urban gardens and peer nutritional counseling intervention was conducted to examine outcomes of HIV-related stigmas and social support. Adult patients (≥18 years of age) with moderate or severe household food insecurity and evidence of suboptimal ART adherence and/or a detectable viral load were enrolled; standard measures of internalized and experienced stigmas and social support were collected at baseline and at 6 and 12 months. Intervention clinic participants received training and materials from agronomists for a home garden, 3-4 sessions of nutritional counseling from the clinic's peer counselor, and a garden produce cooking workshop facilitated by professional nutritionists.

RESULTS

Of 109 study participants (46 intervention and 63 control), 103 (94%) completed 12-month follow-up. Difference-in-differences multivariate longitudinal linear regressions adjusting for sociodemographic factors found that intervention participants had reduced internalized stigma by 3.04 points (scale 0-32) at 12 months (P = 0.002); reduced probability of experiencing HIV-related stigma or discrimination in the past 6 months (20 percentage points at 6 months, P = 0.05 and 25 percentage points at 12 months, P = 0.02); and modestly improved social support at 12 months (1.85 points on 30-pt scale, P = 0.093).

CONCLUSION

A fully powered, larger trial is needed to establish the efficacy of the intervention and assess pathways by which the intervention may improve HIV stigma and social support.

Address: Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA.; RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA.; Department of Medicine, University of California, San Francisco, San Francisco, CA.; Universidad Autónoma de Santo Domingo, Facultad de Ciencias de la Salud, Santo Domingo, Dominican Republic.; RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA.; Currently, Kaiser Permanente Southern California, Pasadena, CA.; RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA.; Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA.; Currently, The Praxis Project, Oakland, CA.; Institute for Health and Aging, School of Nursing, University of California, San Francisco, San Francisco, CA.; Consejo Nacional de VIH/SIDA (CONAVIHSIDA), Santo Domingo, Dominican Republic.; Unidad de Vacunas e Investigación, Instituto Dermatológico, Dominicano y Cirugía de Piel Dr. Huberto Bogaert Diaz, Santo Domingo, Dominican Republic ; and.

DOI: 10.1097/QAI.0000000000003462

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MeSH Terms: Humans, HIV Infections, Male, Female, Dominican Republic, Social Support, Adult, Social Stigma, Counseling, Food Insecurity, Middle Aged, Gardens, Peer Group, Urban Population, Pilot Projects