Interventions to Reduce Self-Stigma Among People Living With HIV: A Systematic Review

Over 4 decades into the global HIV pandemic, HIV-related self-stigma-a mindset of negative beliefs, thoughts, and behaviors a person holds about themselves-remains a major barrier to HIV treatment, management, and care. HIV-related self-stigma is a persistent public health threat and leads to depression and other mental health problems, lowers adherence to antiretroviral medication, and acts as a barrier to health services. Not enough is known about what interventions work and how they work to reduce self-stigma. We conducted a systematic review of existing interventions that address self-stigma among people living with HIV to address this gap. We searched PubMed, Embase, and Web of Science; used Covidence review software; dual-screened the results; extracted data from each included study; analyzed the data using Cochrane guidelines and the Template for Intervention Description and Replication Framework; and categorized the content based on emerging themes around the intervention/program. We included 35 studies in the review, with the majority (32/35, 91%) showing promise to reduce HIV self-stigma or components of self-stigma. Intervention approaches included working on thoughts, feelings, and beliefs through a range of cognitive-based, inquiry-based, and mindful-based techniques, often with a forward-looking goal-setting focus. However, comparison of studies was difficult with different definitions and understandings of self-stigma and different measurement scales. Many studies were small-scale and lacked sufficient in-depth descriptions. This study makes an important contribution to the field of HIV more broadly and HIV-related stigma, specifically, in proposing a common definition of self-stigma and providing in-depth descriptions of interventions in terms of content, type, level, and effectiveness.