Beyond Stigma, Dublin, Ireland.
University College Cork School of Medicine, Department of Public Health & Epidemiology, Cork, Ireland.
Front Public Health. 2023 Jul 28;11:1235150. doi: 10.3389/fpubh.2023.1235150. eCollection 2023.
Self-stigma-negative self-judgements or core beliefs-can result in feelings of shame, worthlessness and self-blame, and impacts social interaction, mental health and health service utilization among people living with HIV (PLHIV). Few interventions target self-stigma among PLHIV and, to our knowledge, none until now for adolescents and young people LHIV (AYPLHIV) in sub-Saharan Africa. We present qualitative findings on the perceived impact of a self-stigma intervention (, "You are Worth it").
The intervention adopted inquiry-based stress reduction (IBSR) at its core-a unique way of identifying and questioning deeply rooted self-stigma, combined with mindfulness, meditation and creativity. The intervention consisted of 16 × 3 hour group sessions. Supporting the intervention was a 156-page activity journal. We utilized a qualitative enquiry to explore the perceived impact of the intervention at various time points between November 2021 and November 2022, with 62 participants ( = 32 female). Discussions explored experiences of being involved in the intervention and any reports on changes in relation to self-stigma and shame. Additionally, we reviewed intervention documentation and creative elements. A thematic analysis guided generation of themes across all data sources.
Both intervention participants and coaches described the transformative effect of the intervention, detailing their experiences before and after. Main themes that emerged were positive changes around: self-confidence, self-agency, sense of purpose/meaning, body positivity, improved communication and personal/family relationships and, forgiveness. The intervention also transferred a set of practical skills on self-inquiry, mindfulness, meditation and creativity that continued to be used in participants' daily lives.
The intervention, using IBSR supported by music, creativity, writing and mindfulness techniques, showed potential for reducing self-stigma and improving self-worth among AYPLHIV. It also transferred practical skills to intervention participants and peer coaches, building their capacity to support others and deal with life challenges beyond HIV. The next phase is to continue supporting the young people to ensure fidelity as the peer coaches deliver the intervention to others. Study results indicate that culturally and practically, interventions to reduce self-stigma and/or improve self-worth operate at various levels and need to be designed and assessed at each level.
自我污名——消极的自我评价或核心信念——可能导致羞耻感、无价值感和自责感，并影响艾滋病毒感染者（PLHIV）的社会互动、心理健康和卫生服务利用。很少有干预措施针对 PLHIV 的自我污名，据我们所知，在撒哈拉以南非洲，目前还没有针对青少年和青年 PLHIV（AYPLHIV）的干预措施。我们提出了定性研究结果，说明了自我污名干预（“你是值得的”）的感知影响。
该干预措施以探究式减压（IBSR）为核心——一种识别和质疑根深蒂固的自我污名的独特方法，结合正念、冥想和创造力。干预措施包括 16 次×3 小时的小组会议。支持该干预措施的是一本 156 页的活动手册。我们利用定性探究在 2021 年 11 月至 2022 年 11 月之间的不同时间点探索了干预措施的感知影响，共有 62 名参与者（=32 名女性）。讨论探讨了参与干预措施的经验以及与自我污名和羞耻感相关的任何变化报告。此外，我们还审查了干预措施文件和创意元素。主题分析指导了所有数据源主题的生成。
干预措施的参与者和教练都描述了干预措施的变革性影响，详细描述了他们在参与之前和之后的经历。出现的主要主题包括以下方面的积极变化：自信、自我决策、目标感/意义感、身体积极性、沟通能力提高、个人/家庭关系改善以及原谅。该干预措施还传授了自我探究、正念、冥想和创造力方面的实用技能，这些技能在参与者的日常生活中继续得到应用。
使用 IBSR 支持的音乐、创造力、写作和正念技术的 干预措施，显示出减少 AYPLHIV 自我污名和提高自我价值的潜力。它还向青年参与者和同伴教练传授了实用技能，增强了他们支持他人和应对 HIV 以外生活挑战的能力。下一阶段是继续支持年轻人，以确保同伴教练在向他人提供干预措施时保持保真度。研究结果表明，在文化和实践上，减少自我污名和/或提高自我价值的干预措施在各个层面上运作，需要在每个层面上进行设计和评估。
