Buddhist Understanding and Reduction of Myanmar Experiences of HIV Stigma and Exclusion

Study Overview
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Brief Summary
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This project aims to explore a multi-leveled conceptualization of the effects of HIV stigma on HIV care engagement in Myanmar by conducting a mixed-method study.

Detailed Description
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This project is to explore how Myanmar People Living With HIV (PLWH) experience and manage HIV stigma as inspired by Buddhist teaching, and to adapt an evidence-based stigma-reduction intervention to tailor treatment for the unique needs of Myanmar People Living With HIV. A stigma-reduction intervention will be adopted to the needs of Myanmar People Living With HIV with six focus groups.

Official Title
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Buddhist Understanding and Reduction of Myanmar Experiences of HIV Stigma and Exclusion

Conditions
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Hiv, Stigma, Social, Mindfulness

Intervention / Treatment
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* Behavioral: Stigma reduction


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: HIV-Positive Care by Myanmar Positive Group/CMRU Living in Myanmar/Thailand can stay in the period of intervention Exclusion Criteria: Not HIV Living outside of Myanmar/Thailand Not care by MPG/CMRU Cannot stay for the study period

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Intervention Model: Single Group Assignment
Interventional Model Description: The intervention is modularized to have eight weekly sessions of 2-hour group discussions, led by a trained facilitator.
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Protocol group<br>The intervention is modularized to eight weekly sessions of 2-hour group discussions. The facilitator applies the principle of Cognitive Behavior Therapy and provides psychoeducation to promote the awareness and understanding of HIV stigma as well as training to help participants acquire alternative coping skills, such as relaxation techniques. In five sessions, participants are introduced to the general cognitive-behavioral model of HIV stigma and are encouraged to track their thoughts, feelings, and behavioral responses when encountering external stigma or adverse events. The participants further learn to differentiate helpful and non-helpful coping strategies and practice applying helpful coping skills to effectively reduce their HIV stigma. In the other three sessions, participants further discuss more specific stigma that intersects with HIV stigma, including stigma in healthcare settings, access to social support, and available resources on the society levels. | Behavioral: Stigma reduction<br>* The intervention is modularized to have eight weekly sessions of 2-hour group discussions, led by a trained facilitator. The facilitator applies the principle of CBT and provides psychoeducation to promote the awareness and understanding of HIV stigma as well as training to help participants acquire alternative coping skills, such as relaxation techniques.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Stigma | HIV stigma was assessed using the Perceived Stigma Scale (PSS), a 40-item scale. Each item is measured using a 4-point Likert type and it contains four factors: personalized stigma (18 items), disclosure concerns (12 items), negative self-image (9 items), and concern with public attitudes about people with HIV (12 items). Each factor (or subscale) is scored separately and the total score is computed by summing the 40 items. Reliability coefficient alphas ranged from 0.90-.93 for the factors and 0.96 for the total scale and 2-3 week test/retest correlations ranged from 0.89-.92 (Berger, Ferrans, & Lashley, 2001). | 8 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| QOL | QOL was measured with Veterans SF (VSF)-12 Quality of Life. VSF-12 is a 12-item health questionnaire developed from the U.S. Each indicator variable is weighted for each of the response choices minus one. The VSF-12 questionnaires have been administered nationally by the Veterans Administration (VA) where there have been more than 2.5 million administrations since 1996. The eight domains are scored from 0 (worst) to 100 (best). The scores are linear transformed t-tests, with 50 as the mean and 10 as the standard deviation (SD) based on a normally distributed population. The VSF-12 was modified from the Medical Outcomes Study 36-item short-form (MOS SF-36) in domains that cover role limitations due to physical and emotional problems by replacement of dichotomized yes/no choices with a 5-point ordinal scale that ranges from no, none of the time to yes, all of the time. These changes increase the precision and discriminatory validity of the role scales, PCS, and MCS. | 8 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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stigma, Mindfulness, Myanmar