HIV Disclosure and Prevention Advocacy Partially Mediate Advocacy Training Intervention Effect on Reduced Internalized HIV Stigma

Reduction of internalized HIV stigma is key to increasing HIV disclosure and engagement in peer advocacy for HIV prevention-and these latter processes may also be important for making further inroads into minimizing stigma. We examined mediators of the effect of a peer advocacy training intervention, Game Changers for HIV Prevention (GC-HIV), on reduced internalized HIV stigma among persons living with HIV (PLWH) in Uganda. A randomized controlled trial was conducted with 210 PLWH (105 in each of the intervention and usual care control arms) who were assessed at baseline and months 6, 12 and 18. Internalized HIV stigma was measured with the 6-item Internalized AIDS-Related Stigma Scale. A repeated measures linear regression model found an intervention effect on reduced internalized HIV stigma. Path analysis performed for each mediator separately revealed that this stigma reduction effect was partially mediated with significant indirect effects for increased HIV disclosure [beta (SE) = - 0.05 (0.03); p = .046] and increased prevention advocacy [beta (SE) = - 0.12 (0.05); p = .01], as well as a significant direct effect; inclusion of both these mediators in the model did not alter this result. HIV knowledge did not act as a mediator of the intervention effect on stigma. Findings support not only the value of the intervention for reducing internalized stigma, but also the benefits of HIV disclosure and encouraging others to protect against HIV for stigma reduction and self-acceptance for PLWH. Clinicaltrials.gov registration (NCT05098015), 2021-10-18.