Reducing Stigma Through Home-based Care in Rural Zambia

Abstract

"Background: HIV-related stigma presents a significant barrier for people living with HIV/AIDS (PLHA) in accessing services and living positively, but research has been limited on ways to reduce it.

Methods: We investigated whether training youth to provide home-based care could affect community stigma in rural communities. We compared the effects of standard HIV prevention training to an enhanced curriculum that trained youth in providing care and support to PLHA. Stigma reduction campaigns were conducted in both areas with local groups and community leaders. Data collection methods included questionnaires and focus groups with youth and PLHA.

Results: At baseline, approximately 20% of youth in both study areas said that PLHA were treated badly by family members, neighbors, and other community members. Quantitative and qualitative results suggest declines in community stigma in the communities where youth received enhanced training in care and support. Youth reported that families responded well to their involvement in caregiving and became more willing to help PLHA with tasks that involve direct contact, such as bathing. PLHA focus group participants described decreased isolation, verbal abuse, and gossip after initiation of the youth caregiving program. At follow-up the proportion of youth caregiver survey respondents who reported that AIDS-affected families were treated worse than others dropped to 9% from 21% (p < 0.05); no similar change was recorded among youth who did not receive care and support training.

Conclusions: The data suggest that regular household visits to PLHA by enthusiastic youth caregivers combined with anti-stigma campaigns helped change negative attitudes and behaviors among families and communities."