WOMEN with HIV (especially minority women) are the fastest-growing HIV population,1 and they often experience the stigma of HIV within the context of poverty.2 Gray3 found that the fear of HIV-related stigma was more of a concern than the fear of dying among women with HIV. The devastating consequence of HIV-related stigma and the need for interventions have been highlighted elsewhere.4

HYPOTHESIS

Women living with HIV who participate in an emotional writing disclosure (EWD) intervention will demonstrate an improved perception of HIV-related stigma compared to women in a control group. EWD is based on the assumption that putting traumatic events into words helps people organize, make sense of, and ultimately reduce intrusive thoughts, a process called cognitive reorganization. EWD has shown social, physiological, and emotional benefits.5-10

METHODS

In this Institutional Review Board-approved pilot study, an experimental design evaluated the impact of EWD on self-perceived HIV-related stigma in women.

Recruitment

Three community peer-leaders (African American, Hispanic, and White women) were hired to aid with recruitment/retention from sites that provided services to women with HIV. Participants were compensated for their time and travel. Some were randomly assigned to an experimental group where they wrote about their feelings related to having HIV; others were assigned to a control group where they wrote on a neutral topic for 3 consecutive days for 20 minutes each day. Power analysis of .80 with 2-tailed alpha level of .05 required 20 for each group-based on the effect size of earlier EWD studies.11

Measurement tools

Women were prescreened for health literacy, cognitive capacity, and physical stamina.12-15 Three women were unable to meet these criteria. Once women with HIV met prescreening criteria, they were included if they were 18 years or older, on antiretroviral drugs, had no major illnesses, were able to speak and write English, and consented to be in the study. All women had 6 contacts: questionnaires on perception of stigma on visit 1 (week 1); writing on visits 2 through 4 (week 1); and stigma questions at visit 5 (week 6) and at visit 6 (week 12). Linguistic Inquiry and Word Count (LIWC), a text analysis software program, evaluated the cognitive reorganization illustrated in the writing for both groups. Average intervention essays contained 2% negative emotion words and 3.1% positive emotion words, compared with 0.6% negative and 1.2% positive emotion words in control groups.16 The Stigma Scale, designed for individuals diagnosed with HIV/AIDS, consisted of 13 items on a 1 to 4 ordinal scale that evaluated fear, avoidance, and perceived negative responses related to HIV status.17 This scale demonstrated an adequate average reliability score for the 3 contacts at weeks 1, 6, and 12 ([alpha] = .87).

SAMPLE

Participants were older than expected; experimental group (n = 21) average age was 43 years, control (n = 23) group's was 45. The average education was the 12th grade for both groups. Seventy-four percent of the participants were African American, suggestive of an ethnically representative sample.

RESULTS

The experimental group compared with the control group reported greater cognitive reorganization (F = 14.235, P = 0.001) and significantly improved perceived HIV-related stigma scores from visit 1 (week 1) to visit 6 (12 weeks) (Wilks [LAMBDA] = 0.178, P = 0.018).

DISCUSSION

The study showed a positive influence on perception of stigma. Further studies with a larger sample, over a longer time, and with a booster are suggestions for the future. Considerations should address the potential for contamination between the 2 groups; participants who knew each other likely discussed the study, despite instructions to the contrary. EWD, an inexpensive and convenient intervention that changed the perception of stigma positively for women with HIV in the experimental group, is a promising finding to advance the health of women.

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