5 - (Sym 21) Change in HIV and Alcohol Use Stigmas over Time in a Trial of a Peer-delivered Behavioral Intervention in Cape Town, South Africa

Background: About one-third of people living with HIV (PLWH) have problem alcohol use, impacting HIV treatment and care. Internalized and enacted stigmas related to HIV and alcohol use are common in this population and have been associated with poorer treatment outcomes. Yet, longitudinal research exploring these relationships is limited. Although contact with individuals with lived experience (also known as “peers”) has been shown to reduce mental health and HIV stigma, little is known about how peer delivery of a structured behavioral intervention can lead to stigma reductions.

Aim: We aimed to examine: (1) how changes in internalized HIV stigma, internalized alcohol stigma, and enacted alcohol stigma were associated with alcohol and HIV outcomes over six-months; (2) whether a peer-delivered, behavioral activation, problem-solving, and mindfulness intervention (Khanya) to reduce problem alcohol use and improve ART nonadherence affected these stigmas; and (3) whether these stigmas acted as mechanisms of change in the intervention.

Methods: Participants were randomized to receive the Khanya intervention (n=30) or enhanced treatment as usual (ETAU; n=31) in Cape Town, South Africa. The alcohol biomarker phosphatidylethanol (PEth) and HIV viral load levels were assessed at baseline, post-treatment (three-months), and six-month follow-up. Tested mediators were alcohol stigma (internalized and enacted) and internalized HIV stigma, measured using the Stigma Mechanisms Scale. A cross-lagged panel model was used to evaluate the aims.

Results: We found significant lagged effects between all forms of stigma and PEth. Greater enacted alcohol stigma at baseline (B=0.152, p=0.034), greater internalized HIV stigma at baseline (B=0.205, p=0.004), and higher internalized alcohol stigma at post-treatment (B=0.211, p=0.017) were associated with higher PEth values at the subsequent timepoint. There were no significant treatment effects on stigma (p>0.05) nor did stigma act as a mediator.

Discussion: Greater HIV and alcohol stigmas were predictive of worse biologically-measured alcohol use outcomes over six-months, indicating a relevant treatment target. However, the use of a peer-delivered behavioral intervention without an explicit focus on stigma did not result in reduced alcohol or HIV stigmas in this population. Future research should test whether enhancing the peer’s role to include greater self-disclosure of lived experience and other stigma reduction strategies lead to reductions in internalized stigma in this population.