An agricultural livelihood intervention is associated with reduced HIV stigma among people living with HIV

Sheri D Weiser; Lila A Sheira; Elly Weke; Jennifer M Zakaras; Pauline Wekesa; Edward A Frongillo; Rachel L Burger; Adrienne Rain Mocello; Harsha Thirumurthy; Shari L Dworkin; Alexander C Tsai; James G Kahn; Lisa Butler; Elizabeth A Bukusi; Craig R Cohen

doi:10.1097/QAD.0000000000003928

An agricultural livelihood intervention is associated with reduced HIV stigma among people living with HIV

AIDS. 2024 May 16. doi: 10.1097/QAD.0000000000003928. Online ahead of print.

Authors

Affiliations

¹ Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, SFGH 100, San Francisco, CA, 94110, USA.
² Centre for Microbiology Research, Kenya Medical Research Institute, P.O. Box 54840 00200 Off Raila Odinga Way, Nairobi, Kenya.
³ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, Discovery I, 915 Greene Street, University of South Carolina, Columbia, South Carolina, 29208, USA.
⁴ Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
⁵ Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Blockley Hall, Philadelphia, PA, 19104-4884, USA.
⁶ School of Nursing and Health Studies, University of Washington Bothell, 18115 Campus Way NE, Bothell, WA, 98011, USA.
⁷ Center for Global Health and Mongan Institute, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, 02114, USA.
⁸ Department of Epidemiology and Biostatistics, University of California, San Francisco, 3333 California Street, San Francisco, CA, 94118, USA Title Page.
⁹ Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, 2006 Hillside Road, Storrs, CT, 06269-1248, USA.

PMID: 38752558
DOI: 10.1097/QAD.0000000000003928

Abstract

Objective: HIV stigma undermines antiretroviral treatment (ART) adherence and viral suppression. Livelihood interventions may target drivers of negative attitudes towards people living with HIV (PLHIV) by improving their health and strengthening their economic contributions. We examined the effects of a multisectoral agricultural livelihood intervention on HIV stigma among PLHIV in western Kenya.

Design: Sixteen health facilities were randomly allocated (1:1) to intervention or control arms in Shamba Maisha, a cluster randomized controlled trial that aimed to improve HIV-related health through behavioral, mental health, and nutritional pathways.

Methods: The intervention included a farming loan and agricultural and financial training. Participants had access to farmland and surface water and were ≥18 years old, on ART >six months, and moderately-to-severely food insecure. We measured internalized, anticipated, and enacted HIV stigma semiannually over two years using validated scales. In blinded intent-to-treat analyses, we compared changes in scores over 24 months, by study arm, using longitudinal multi-level difference-in-differences linear regression models that accounted for clustering.

Results: Of 720 enrolled participants (354 intervention), 55% were female, and the median age was 40 years (interquartile range 34-47 years). Two-year retention was 94%. Compared to the control arm, the intervention resulted in significant decreases (p < 0.001) of 0.42 points (95% confidence interval (CI) -0.52, -0.31) in internalized stigma, 0.43 points (95% CI -0.51, -0.34) in anticipated stigma, and 0.13 points (95% CI -0.16, -0.09) in enacted stigma over 24 months.

Conclusions: The agricultural livelihood intervention reduced HIV stigma among PLHIV. Poverty-reduction approaches may be a novel strategy for reducing HIV stigma.