What Do We Know About Interventions to Reduce Intersectional Stigma and Discrimination in the Context of HIV? A Systematic Review.

Abstract

There is ample literature on interventions to reduce human immunodeficiency virus (HIV) stigma and discrimination and extant theory around intersectionality. However, the integration of intersectionality into the design and implementation of stigma reduction interventions is nascent. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we reviewed 23 studies from six countries to examine the state of the evidence on interventions to reduce intersectional stigma in the context of HIV. Thirteen studies made explicit reference to intersectionality, 11 of which addressed all three stigma domains: drivers, facilitators, and manifestations. Most interventions were multilevel and multistrategy, yet only five included a structural component. Thirteen studies focused on four or more intersections (e.g., HIV, race, sexual identity, gender), five on three intersections, and five on two intersections. Twenty studies (87%) reported medium (n = 5) to high (n = 15) community engagement. The majority of studies (19/23) assessed HIV-related (e.g., antiretroviral therapy [ART] adherence) and/or empowerment-based outcomes (e.g., self-esteem, coping), with 91% reporting some positive intervention effects. Of 13 studies that measured stigma outcomes, only seven (54%) documented some improvement in the stigma measures assessed. Our review revealed a range of sophisticated, intersectionality-informed interventions that were mostly successful at improving HIV, sexual health, and empowerment-based outcomes, but less successful at reducing the aspects of stigma measured. Future research should encompass wider geographical regions, use validated measures of intersectional stigma, and test structural interventions and approaches that challenge the systems of power and oppression that fuel stigma, inequality, and poor health outcomes among multiply marginalized populations.