Department of Health Promotion and Policy, University of Massachusetts Amherst, Amherst, MA.
RAND Corporation and Pardee RAND Graduate School, Santa Monica, CA.
J Acquir Immune Defic Syndr. 2024 Sep 1;97(1):55-62. doi: 10.1097/QAI.0000000000003462.
Food insecurity and HIV-related stigma negatively affect HIV outcomes. Few studies have examined how food security interventions affect HIV-related stigma and social support.
Two HIV clinics in the Dominican Republic.
A pilot cluster randomized controlled trial of an urban gardens and peer nutritional counseling intervention was conducted to examine outcomes of HIV-related stigmas and social support. Adult patients (≥18 years of age) with moderate or severe household food insecurity and evidence of suboptimal ART adherence and/or a detectable viral load were enrolled; standard measures of internalized and experienced stigmas and social support were collected at baseline and at 6 and 12 months. Intervention clinic participants received training and materials from agronomists for a home garden, 3-4 sessions of nutritional counseling from the clinic's peer counselor, and a garden produce cooking workshop facilitated by professional nutritionists.
Of 109 study participants (46 intervention and 63 control), 103 (94%) completed 12-month follow-up. Difference-in-differences multivariate longitudinal linear regressions adjusting for sociodemographic factors found that intervention participants had reduced internalized stigma by 3.04 points (scale 0-32) at 12 months (P = 0.002); reduced probability of experiencing HIV-related stigma or discrimination in the past 6 months (20 percentage points at 6 months, P = 0.05 and 25 percentage points at 12 months, P = 0.02); and modestly improved social support at 12 months (1.85 points on 30-pt scale, P = 0.093).
A fully powered, larger trial is needed to establish the efficacy of the intervention and assess pathways by which the intervention may improve HIV stigma and social support.
食物不安全和与 HIV 相关的耻辱感会对 HIV 结果产生负面影响。很少有研究探讨粮食保障干预措施如何影响与 HIV 相关的耻辱感和社会支持。
多米尼加共和国的两个 HIV 诊所。
对城市花园和同伴营养咨询干预措施进行了一项试点性集群随机对照试验，以检验与 HIV 相关的耻辱感和社会支持的结果。研究对象为成年患者（≥18 岁），他们有中度或重度家庭食物不安全，并且有证据表明抗逆转录病毒治疗（ART）依从性不佳和/或病毒载量可检测到；在基线和 6 个月及 12 个月时，采用标准方法收集内化和经验性耻辱感以及社会支持的指标。干预诊所的参与者接受了农学家的家庭花园培训和材料、诊所同伴顾问的 3-4 次营养咨询，以及专业营养师组织的花园农产品烹饪讲习班。
在 109 名研究参与者（46 名干预组和 63 名对照组）中，有 103 名（94%）完成了 12 个月的随访。经过调整社会人口因素的差异差异多变量纵向线性回归分析，发现干预组参与者在 12 个月时的内化耻辱感降低了 3.04 分（0-32 分）（P = 0.002）；在过去 6 个月内经历与 HIV 相关的耻辱或歧视的可能性降低了 20 个百分点（6 个月时为 20 个百分点，P = 0.05，12 个月时为 25 个百分点，P = 0.02）；并且在 12 个月时社会支持略有改善（30 分制的 1.85 分，P = 0.093）。
需要进行更大规模的、完全有力的试验，以确定该干预措施的疗效，并评估该干预措施可能改善 HIV 耻辱感和社会支持的途径。
