Table 2 Overview of the Maisha intervention
Session information | Content | Goals |
|---|---|---|
Maisha 1  Population: all intervention participants (women only or couples); separate guides for participants with unknown HIV status and participants with known HIV diagnosis  Timing: before standard of care ANC visit | Watch 8-min video telling the story of Salma and Bahati, a couple who test for HIV at their antenatal care visit and learn how to navigate their diagnosis Review video and discuss topics related to both Salma and participant: • Feelings during HIV testing • Thoughts about the future • Anxieties related to HIV testing • Importance of HIV care engagement • Supportive individuals Introduce and discuss the three types of stigma: internalized, enacted, anticipated Final messages • If you test positive, there are medications available and people who can support you • If you test negative, you can be a source of support for other people who have HIV For participants with a known HIV diagnosis, the session involves a discussion of how the video and types of stigma relate to the participants’ own experiences of living with HIV | • Normalize HIV and increase empathy for people living with HIV • Raise consciousness regarding HIV stigma, and rethink stigmatizing attitudes • Prepare participants for HIV testing and acceptance of a possible HIV diagnosis |
Maisha 2  Population: all intervention participants with an HIV diagnosis (couples attend if at least one person in the couple has an HIV diagnosis); separate guides for new HIV diagnoses and established HIV diagnoses  Timing: same day as Maisha 1, after ANC visit | Link back to video to provide hope for the future and address the three types of HIV stigma: Internalized stigma • Acknowledge negative emotions • Reassure about accepting one’s HIV status with time Anticipated stigma • Acknowledge worries • Reassure about their future Enacted stigma • Acknowledge that it may take time to disclose and get support Identify values and link to adherence/care engagement Final messages • Acceptance is a process that takes time • Your values can help you commit to taking treatment and attending the clinic | • Address immediate stigma-related concerns and provide reassurance • Create commitment to treatment and a plan to return to the same clinic for the next HIV appointment |
Maisha 3  Population: all HIV-infected female intervention participants (women only); separate guides for new HIV diagnoses and established HIV diagnoses  Timing: 2 weeks after Maisha 2 | Link back to video to help the client develop an action plan, addressing the three types of stigma: Internalized stigma • Discuss feelings about oneself as someone living with HIV • Action plan for how one can come to accept self as someone living with HIV Anticipated stigma • Discuss worries related to attending the clinic (especially related to others learning about one’s HIV status) • Action plan for attending clinic and taking ARVs Enacted stigma • Discuss any disclosures and support • Action plan for disclosing and/or harnessing support to stay in care Discuss HIV and personal care, including: • Check-in on taking medication • Establish connections between thoughts and feelings using a CBT model; discuss coping mechanisms • Introduce a mindfulness/breathing exercise • Discuss challenges and make a commitment to care Final messages • Just taking the step to be here at this session and at the clinic is an important one and something to be proud of • Acknowledging and addressing worries can help us stay positive and find support • It is important to keep coming to care and taking medications | • Build on the previous sessions to prevent or reduce internalized and anticipated stigma • Develop strategies to cope with or mitigate enacted stigma, while getting support • Develop commitment to PMTCT care, and create a plan for overcoming barriers to care |