2. Public Level Individual Level Race Gender Health Condition(s) Internalized Stigma Poor Treatment Utilization Poor Health Outcomes Culture (Social norms, shared beliefs about body, health & illness, power structures) Public Stigma Institutionalized Stigma 1 Rao et al., 2007 2 Rao et al., 2011 Race Gender (Other Statuses) Poor Treatment Utilization Culture (Social norms, power structures, shared beliefs about body, health & illness,) Public Stigma Institutionalized Stigma

3. Societal level 1 – Removal of institutional stigmas – Microfinance programs (economic empowerment) – Community organizing Individual level 2,3 – Education/Information – Coping Skills Acquisition – Contact with Affected Persons (e.g. Social Support) 1 Link & Phelan, 2001; 2 Brown, Trujillo, Macintyre, 2001; 3 Corrigan, 2011

4. HIV Stigma Toolkit developed by International Center for Research on Women (ICRW) 1 – Developed in Zambia, facilitators trained globally – We chose from 40+ exercises based on focus groups feedback We developed ‘trigger videos’ from Toolkit scenarios/focus group content in order to – model proactive behaviors – trigger discussion 1 Kidd, Clay, Chiiya, 2007

5. Piloted as 8-hour workshop across 2 afternoons Peer facilitated Group setting Participants – 24 African American women living with HIV – Living with HIV from 3 months to 25 years

6. “Group Expectations” (e.g. Mutual Respect, No right or wrong answers) Personal Experiences of Stigma Coping with Stigma (sharing methods) Role play – navigating stigmatizing situations

7. Web of String represented “Peace,” “Unity,” “Togetherness”

9. Pre-test post-test design Paired t-tests Primary outcome: Stigma Scale for Chronic Illness (SSCI), 14 item scale adapted for African-Americans living with HIV 1 1 Rao, Choi, et al., 2009; Rao, Molina, et al., under review

10. Day 1 to 2: t=2.05 (df=20), p=0.054 Day 1 to Day 8: t=1.95 (df=18), p=0.067

11. No control group Trends/non-significance likely related to small sample size Booster session potentially helpful Next step: randomized clinical trial

12. Our Participants Tom Furtwangler (Video Producer), James and Margaret Longley (Camera and Sound), Yamile Molina (Scripting) NIH K23 MH 084551 Questions? deeparao@uw.edu