A multilevel intervention to reduce stigma among alcohol consuming men living with HIV receiving antiretroviral therapy: findings from a randomized control trial in India.

OBJECTIVE To examine the effectiveness of a multilevel intervention to reduce HIV stigma among alcohol consuming men living with HIV in India. DESIGN A crossover randomized controlled trial in four sites. SETTING Government ART centres (ARTCs) offering core services in the greater Mumbai area. PARTICIPANTS Seven hundred and fifty two (188 per site) alcohol-consuming male PLHIV on ART were recruited. INTERVENTION Multilevel intervention to reduce alcohol consumption and promote adherence by addressing stigma, implemented at the individual (individual counselling, IC), group (group intervention, GI) and community levels (collective advocacy, CA) in three distinct sequences over three cycles of 9 months each. MAIN OUTCOME MEASURE HIV stigma, measured using the 16-item Berger Stigma scale. METHODS The article examines the effectiveness of the interventions to reduce stigma using Linear Mixed Model regression. RESULTS At baseline, 57% of participants had moderate-high levels of stigma (scores >40). All three counseling interventions were effective in reducing stigma when delivered individually, in the first cycle (collective advocacy: βcoeff = -9.71; p < 0.001; group intervention: βcoeff = -5.22; p < 0.001; individual counselling: βcoeff = -4.43; p < 0.001). At then end of the second cycle, effects from the first cycle were sustained with no significant change in stigma scores. At the end of the third cycle, the site, which received CA+IC+GI sequence had maximum reduction in stigma scores (βcoeff = -10.29; p < 0.001), followed by GI+CA+IC (βcoeff = -8.23, p < 0.001). CONCLUSION Baseline findings suggest that stigma remains a problem even with experienced patients, despite advances in treatment and adherence. Results of multilevel stigma reduction interventions argue for inclusion in HIV prevention and treatment program.