A conceptual model exploring the relationship between HIV stigma and implementing HIV clinical trials in rural communities of North Carolina.
BACKGROUND
HIV/AIDS disproportionately affects minority groups in the United States, especially in the rural southeastern states. Poverty and lack of access to HIV care, including clinical trials, are prevalent in these areas and contribute to HIV stigma. This is the first study to develop a conceptual model exploring the relationship between HIV stigma and the implementation of HIV clinical trials in rural contexts to help improve participation in those trials.


METHODS
We conducted focus groups with HIV service providers and community leaders, and individual interviews with people living with HIV/AIDS in six counties in rural North Carolina. Themes related to stigma were elicited. We classified the themes into theoretical constructs and developed a conceptual model.


RESULTS
HIV stigma themes were classified under the existing theoretical constructs of perceived, experienced, vicarious, and felt normative stigma. Two additional constructs emerged: causes of HIV stigma (e.g., low HIV knowledge and denial in the community) and consequences of HIV stigma (e.g., confidentiality concerns in clinical trials). The conceptual model illustrates that the causes of HIV stigma can give rise to perceived, experienced, and vicarious HIV stigma, and these types of stigma could lead to the consequences of HIV stigma that include felt normative stigma.


CONCLUSIONS
Understanding HIV stigma in rural counties of North Carolina may not be generalizeable to other rural US southeastern states.


CONCLUSIONS
The conceptual model emphasizes that HIV stigma--in its many forms--is a critical barrier to HIV clinical trial implementation in rural North Carolina.
Sengupta
Sohini
S
Department of Social Medicine, School of Medicine, Center for Faculty Excellence, University of North Carolina at Chapel Hill, USA. sengups@unc.edu
Strauss
Ronald P
RP
Miles
Margaret S
MS
Roman-Isler
Malika
M
Banks
Bahby
B
Corbie-Smith
Giselle
G
D000328:Adult; D001741:Black or African American; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009657:North Carolina; D011204:Poverty Areas; D011287:Prejudice; D012424:Rural Population
D044966:Anti-Retroviral Agents