Identifying “What Matters Most” to Men in Botswana to Promote Resistance to HIV-Related Stigma

Misra, Supriya; Mehta, Haitisha; Eschliman, Evan L.; Rampa, Shathani; Poku, Ohemaa; Wang, Wei Qian; Ho-Foster, Ari; Mosepele, Mosepele; Becker, Ted; Entaile, Patlo; Arscott-Mills, Tonya; Opondo, Phillip R.; Blank, Michael B.; Yang, Lawrence H.

doi:10.1177/10497323211001361

Cited by 10 publications

(6 citation statements)

References 56 publications

(87 reference statements)

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“…Leveraging cultural values and strengths to challenge gender-based and intersecting stigmas is a promising direction for future research. As found in qualitative studies in Botswana informed by cultural capabilities approaches that identify what matters most to "manhood" (Misra et al, 2021) and "womanhood" (Yang et al, 2021), HIVrelated stigma reduction interventions can leverage capabilities to fulfill socially prescribed gender roles (e.g., men's roles as providers, women's roles as mothers). In this way, "achieving culturally valued aspects of personhood in one's local moral world can counter both perceived stigma from others and internalized stigma applied to the self" (Misra et al, 2021(Misra et al, , p. 1691.…”

Section: Discussionmentioning

confidence: 99%

Experiences of gender-based stigma and health care-related outcomes in the African region: A scoping review.

Logie,

Earnshaw,

Ahmed

et al. 2024

Stigma and Health

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Section: Discussionmentioning

confidence: 99%

Experiences of gender-based stigma and health care-related outcomes in the African region: A scoping review.

Logie,

Earnshaw,

Ahmed

et al. 2024

Stigma and Health

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“…Low barrier testing and treatment models should accommodate work schedules and prioritize confidentiality and privacy [33] which were both highlighted by participants as essential for care engagement. Same day initiation strategies are essential to preserving physical strength and earning potential [34]. Men may be more receptive to home-based testing initiatives, mobile clinics, and education about the utility of ART and TB treatments for preserving strength and earning capacity [35].…”

Section: Discussionmentioning

confidence: 99%

“…Men may be more receptive to home-based testing initiatives, mobile clinics, and education about the utility of ART and TB treatments for preserving strength and earning capacity [35]. From a structural standpoint, engaging men will require formal employment protections that prevent employment discrimination and allow reasonable accommodation for healthcare attendance [34].…”

Section: Discussionmentioning

confidence: 99%

Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa

Bergman

McNabb

Mlandu³

et al. 2023

PLOS Glob Public Health

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While stigma experienced by people living with HIV (PLWH) is well documented, intersectional stigma and additional stigmatized identities have not received similar attention. The purpose of this metasynthesis is to identify salient stigmatized intersections and their impact on health outcomes in PLWH in sub-Saharan Africa. Using Sandelowski and Barroso’s metasynthesis method, we searched four databases for peer-reviewed qualitative literature. Included studies (1) explored personal experiences with intersecting stigmas, (2) included ≥1 element of infectious disease stigma, and (3) were conducted in sub-Saharan Africa. Our multinational team extracted, aggregated, interpreted, and synthesized the findings. From 454 screened abstracts, the 34 studies included in this metasynthesis reported perspectives of at least 1258 participants (282 men, 557 women, and 109 unspecified gender) and key informants. From these studies, gender and HIV was the most salient stigmatized intersection, with HIV testing avoidance and HIV-status denial seemingly more common among men to preserve traditional masculine identity. HIV did not threaten female identity in the same way with women more willing to test for HIV, but at the risk of abandonment and withdrawal of financial support. To guard against status loss, men and women used performative behaviors to highlight positive qualities or minimize perceived negative attributes. These identity management practices ultimately shaped health behaviors and outcomes. From this metasynthesis, the Stigma Identity Framework was devised for framing identity and stigma management, focusing on role expectation and fulfillment. This framework illustrates how PLWH create, minimize, or emphasize other identity traits to safeguard against status loss and discrimination. Providers must acknowledge how stigmatization disrupts PLWH’s ability to fit into social schemas and tailor care to individuals’ unique intersecting identities. Economic security and safety should be considered in women’s HIV care, while highlighting antiretrovirals’ role in preserving strength and virility may improve care engagement among men.

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“…A detailed discussion of the methods for each of the four component studies is available elsewhere. 7,8,[14][15][16] Here, we describe key elements of each study's methods to provide an overview of the overall process across the studies. Applying WMM enabled a theory-driven, four-stage process: 1) initial qualitative work, generating results to inform; 2) development and validation of an HIV stigma scale capturing participant-identified, culturally-salient norms that contribute to and enable resistance to stigma.…”

Section: Methodsmentioning

confidence: 99%

“…1) Qualitative Study: identifying WMM for men and women in Botswana and examining how the fulfillment of these goals is shaped by HIV and structural vulnerability in Botswana 15 , 16 …”

Section: Introductionmentioning

confidence: 99%

Theory-Driven, Multi-Stage Process to Develop a Culturally-Informed Anti-Stigma Intervention for Pregnant Women Living with HIV in Botswana

et al. 2022

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Background and Objectives: Despite a well-established universal HIV diagnosis and treatment program, Botswana continues to face a high HIV prevalence, in large part due to persistent stigma, which particularly affects pregnant women and interferes with healthcare engagement. Tackling stigma as a fundamental cause of HIV disparities is an important but understudied aspect of current HIV interventions. Our multinational and multicultural team used a theory-driven, multi-stage iterative process to develop measures and interventions to first identify and then target the most culturally-salient aspects of stigma for mothers living with HIV in Botswana. This methodology report examines the stage-by-stage application of the “What Matters Most” (WMM) theory and lessons learned, sharing a replicable template for developing culturally-shaped anti-stigma interventions. Methods: First, we conducted initial qualitative work based on the WMM theory to identify key structural and cultural factors shaping stigma for women living with HIV in Botswana. Second, we developed a psychometrically validated scale measuring how “what matters most” contributes to and protects against stigma for this population. Third, we designed an anti-stigma intervention, “Mothers Moving towards Empowerment” (MME), centered on the local values identified using WMM theory that underly empowerment and motherhood by adapting a cognitive behavioral therapy (CBT)-informed, group-based, and peer-co-led anti-stigma intervention specifically for pregnant women living with HIV. Fourth, we conducted a pilot study of MME in which participants were allocated to two trial arms: intervention or treatment-as-usual control. Results: Our qualitative research identified that bearing and caring for children are capabilities essential to the concept of respected womanhood, which can be threatened by a real or perceived HIV diagnosis. These values informed the development and validation of a scale to measure these culturally-salient aspects of stigma for women living with HIV in Botswana. These findings further informed our intervention adaptation and pilot evaluation, in which the intervention group showed significant decreases in HIV stigma and depressive symptoms compared to the control group. Participants reported overcoming reluctance to disclose their HIV status to family, leading to improved social support. Conclusion and Global Health Implications: Previous studies have not utilized culturally-based approaches to assess, resist, and intervene with HIV-related stigma. By applying WMM in each stage, we identified cultural and gendered differences that enabled participants to resist HIV stigma. Focusing on these capabilities that enable full personhood, we developed an effective culturally-tailored anti-stigma intervention for pregnant women living with HIV in Botswana. This theory-driven, multi-stage approach can be replicated to achieve stigma reduction for other outcomes, populations, and contexts. Copyright © 2022 Poku et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

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Identifying “What Matters Most” to Men in Botswana to Promote Resistance to HIV-Related Stigma

Cited by 10 publications

References 56 publications

Experiences of gender-based stigma and health care-related outcomes in the African region: A scoping review.

Experiences of gender-based stigma and health care-related outcomes in the African region: A scoping review.

Identity management in the face of HIV and intersecting stigmas: A metasynthesis of qualitative reports from sub-Saharan Africa

Theory-Driven, Multi-Stage Process to Develop a Culturally-Informed Anti-Stigma Intervention for Pregnant Women Living with HIV in Botswana

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