By Saumya Sao

On November 1st, 2019, the Center had its first lunch talk in the 2019-2020 Reproductive Health in Africa lunch series. The panel focused on HIV stigma and reproductive health. I had the pleasure of moderating the panel, which was made up by: Megan Huchko, MD, MPH who is an OB/GYN and directs the Center for Global Reproductive Health at DGHI; Michael Relf, PhD, RN who is the Associate Dean for Global and Community Affairs in the School of Nursing; and Godfrey Kisigo, MBChB, who is a second year MSc-GH student and Tanzanian physician.

Over the past year, I’ve had the privilege of working with Godfrey on a team led by Dr. Melissa Watt. Our team has been developing and carrying out an HIV stigma reduction intervention in Moshi, Tanzania. Throughout just two years of studying global sexual and reproductive health, I’ve seen how critical it is to consider the impact of stigma on care engagement and reproductive health education, so I was very glad to see this panel come together, and have three experts share their experience with students, faculty, staff, and other community members.

HIV stigma is crucial to address because it impedes care engagement at each step of the HIV care continuum, and overall reduces the quality of life of people living with HIV. At the stage of diagnosis, perceptions of HIV stigma can create a fear of testing, preventing people from learning their HIV status. At the stage of receipt and retention to care, people living with HIV might avoid clinics for fear of consequences that could come from involuntary status disclosure. And finally, HIV stigma acts as a barrier to reaching viral suppression, as people living with HIV might miss medication doses if they are not able to take pills discreetly.

Megan Huchko shared her new R21, which aims to develop a framework for intersectional stigma to capture the interaction of HIV stigma, HPV stigma, and cervical cancer stigma in western Kenya. Partnering with Family AIDS Care and Education Services (FACES) and the Kenya Medical Research Institute (KEMRI), Huchko’s team has conducted in-depth interviews with a number of key stakeholders and is currently working on analyzing those interviews and developing a scale to measure intersectional stigma. Stigma related to HIV and HPV has not yet been well-characterized, so this work is important for understanding and improving care engagement among this population!

Michael Relf shared his experience working to understand HIV stigma in the US and beyond. Relf’s team developed a video intervention grounded in formative research that was designed to mitigate internalized stigma among women living with HIV in the deep south. He is now collaborating with partners in Rwanda and Tanzania to adapt the intervention to these two countries.

Finally, Godfrey Kisigo shared the Maisha intervention, which is a stigma reduction intervention administered in an antenatal care setting in Moshi, Tanzania. The team is led on the Duke side by Dr. Melissa Watt and is a partnership with the Kilimanjaro Clinical Research Institute. Kisigo shared insights from an observational study that explored postpartum HIV care engagement in Tanzania and found that stigma largely contributed to poor retention in care for women living with HIV, which was the inspiration behind the Maisha study and intervention. The team developed a video and counselling intervention curriculum and has now enrolled 1500 pregnant women and their male partners in the study!

The panel shed light on a topic that is critical to the improving reproductive health globally yet is still not discussed nearly enough. It was inspiring to hear the variety of work being done at Duke to address HIV stigma globally. You can watch the recording of the lunch talk here. Be on the lookout for the next lunch talk in Spring 2020!

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