International Journal of Social Science Tomorrow

Vol. 2 No. 1

Impact of Psycho-Education on Stigma in People Living with HIV/AIDS

Lakshmi M G, PhD Research Scholar, University of Mysore, Mysore Dr. Sampathkumar, Assistant Professor, University of Mysore, Mysore

Abstract
Aim: The aim of the study was to determine the effect of Psycho-education on reducing Stigma in People living with HIV/AIDS Study design: Pre and post experimental design. Place and Duration of Study: ART centre, Krishnarajendra Government Hospital Mysore, Karnataka between Jan 2012 to July 2012 Method: For the study 120 People living with HIV/AIDS were selected between the age of 20-40 years, who have high Stigma score on Stigma scale. The selected People living with HIV/AIDS were divided into two groups, i.e. experimental group and control group. Experimental group was provided Psycho-education and control group was kept under observation. Data were analysed using General linear model repeated measures of ANOVA. Results: Findings indicated that Psycho- education reduced the level of HIV-related stigma in the target population. The intervention demonstrated positive attitude changes associated with HIV-related stigma. It is also found that there is no significant difference between men and women in reduction of stigma. Conclusion: Psycho-education has made positive impact on Stigma and its factors namely, Personalised stigma, Disclosure concern, Negative self image, Public attitudes in PLWHA Keywords: PLWHA, Stigma, Psycho-Education

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1. Introduction
According to UNAIDS global report (2009), it is estimated that there are 33.3 million people worldwide and 4.9 Million people in Asian continental infected with HIV/AIDS. According to National Aids Control Organization (NACO) report 2010, India has 2.27 million HIV-infected persons, the third highest in the world after South Africa and Nigeria. According to Karnataka State Aids Prevention Society (KSAPS) Consolidated ART report July 2012, the scenario of Karnataka state is 0.223 million adult . HIV/AIDS researchers are projecting an estimated 65 million deaths from AIDS by the year 2020; more than triple the number who died in the first 20 years of the epidemic unless major efforts are put toward primary prevention or major developments in treatment take place (Altman, 2002). Human immunodeficiency virus (HIV) is a retrovirus that infects cells of the immune system, destroying or impairing their function. As the infection progresses, the immune system becomes weaker, and the person becomes more susceptible to infections. The most advanced stage of HIV infection is acquired immunodeficiency syndrome (AIDS). It may take 10-15 years for an HIV-infected person to develop AID (WHO). People living with HIV/AIDS (PLWHA) suffer physically, mentally, psychologically and even from economic criteria. Such persons are most of the times discriminated on the basis of stigma attached to the means of acquiring HIV and they may be ill treated and isolated from family members and face discrimination from society, which affect quality of life in PLWHA( Henderson & Thornicroft 2009). There is a pressing need for attention from psychologists and counsellors to guide PLWHA on coping skills and effective intervention. Brown, Trujillo and Macintyre (2001) suggest that AIDS stigma can be reduced through intervention strategies including information, counseling, coping skills and acquisition, and contact with affected groups.

2. Stigma

According to the Encarta Dictionary definition of stigma is a disgrace or a reproach attached to something. Stigma is often described as the negative labels or stereotypes used when talking about something or somebody. Goffman(1963) defines stigma, in general, as an undesirable or discrediting attribute that an individual possesses, thus reducing that individuals status in the eyes of society. Herek(1998) defines AIDS stigma as prejudice, discounting, discrediting, and discrimination directed at people perceived to have AIDS or HIV, and the individuals, groups and communities with which they are associated. The WHO cites fear of stigma and discrimination as the main reason why people are reluctant to be tested, to disclose HIV status or to take antiretroviral drugs.. Nattabi , Li , Thompson , Orach , Earnest (2009) in their study quantified the burden of stigma and examined factors associated with stigma among people living with HIV in Gulu, northern Uganda. Verbal abuse and negative self-perception were more common forms of stigma. The association between antiretroviral therapy and stigma suggested that organizational aspects of antiretroviral delivery may lead to stigmatization. Result suggested to use Interventions such as counseling, education of health workers and the community would lead to reductions in negative self-perception and verbal abuse and in turn improve the quality of life for PLWHA. Sheng Wu, Li Li (2006) in a study saw an effect of a brief intervention which aimed at reducing HIV-related stigma among service providers in China who from four county hospitals in the Yunnan province of China. Brief intervention includes small group activities, including role-plays, games, group discussions, and testimony by an HIV advocate, Results suggest some stigma reduction interventions appear to work, at least on a small scale and in the short term, but many gaps remain especially in relation to scale and duration of impact and in terms of gendered impact of stigma reduction interventions Cognitive behavioral stress management intervention (CBSM) appears to have a significant role to play in the management of HIV spectrum disease. This includes ameliorating distress, improving patient adherence to medical regimens, and facilitating the efforts of HIV-infected women and men to cope effectively with their chronic disease. The results seen was increased quality and quantity of life ( Neil, Schneiderman., Michael, Antoni., Gail Ironson 2011). Nonetheless, the existing literature didnt focus on the role of Psycho-education in reducing stigma, discrimination. Combining counseling and information-based approaches that break the "culture of silence" associated with HIV/AIDS and promote a culture of openness and support, can have a catalytic effect-starting a chain reaction that reduces stigma and discrimination and eventually also prevalence of HIV in the community (Bajaj , Kalia, 2004).

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So, the present study introduces Psycho-education intervention based on findings and lessons from previous qualitative and quantitative studies on Stigma. Corrigan & OShaughnessy (2007) list three main avenues for addressing the stigma discrimination associated with any mental disturbance: protest, education, and contact. Interventions based on any of these principles leave much to be desired. The term psycho-education comprises systemic, didactic-psychotherapeutic interventions, which are adequate for informing patients and their relatives about the illness and its treatment, facilitating both an understanding and personally responsible handling of the illness and supporting those afflicted in coping with the disorder. The roots of psycho-education are to be found in behavioral therapy, although current conceptions also include elements of client-centered therapy in various degrees. Within the framework of psychotherapy, psychoeducation refers to the components of treatment where active communication of information, exchange of information among those afflicted and also involve imparting knowledge, facilitating understanding and application, developing psychomotor skills, or bringing about affective or attitudinal change. Psycho-education is also often provided to a client's significant others to, at the minimum, help them to cope with the individual's problem, and, at the optimum, enable them to be effective components of the treatment and recovery process. Important elements in psycho-education are: Information transfer (symptomatology of the disturbance, causes, treatment concepts, etc.) Emotional discharge (understanding to promote, exchange of experiences with others concerning, contacts, etc.) Support of a medication or psychotherapeutic treatment, as cooperation is promoted between the mental health professional and patient (compliance, adherence). Assistance to self-help (e.g. training, as crisis situations are promptly recognized and what steps should be taken to be able to help the patient). Psycho-education is not necessarily psychotherapy as it does not exclusively deal with psychological or mental illness but rather any condition you or a relative or a friend is experiencing. For example breast cancer is not a mental illness however a person with breast cancer may feel anxious, disheartened and scared about their condition and therefore it is said that the cancer is bringing about psychological stressors. Research has shown that the more a person is aware of their illness and how it affects their own lives and that of others, the more control that person has over their illness. This means that, with appropriate knowledge and techniques, episodes of mental illness occur less often and are usually less severe in intensity and duration Psycho-education can be implemented in a number of different formats and settings. The format depends entirely on the disorder, the developmental age of the individual and their individual needs. Psycho-education can be Individual based Family based Group based Psycho-education most commonly involves the individual with the disorder, the patient or client, but in some situations psycho-education is implemented only to the people who deal with the patient on a day to day basis such as family, friends, teachers or caretakers.

3. Carol M Andersons Psycho-Education

The popularization and development of the term psycho-education into its current form is widely attributed to the American researcher Anderson in 1980 in the context of the treatment of schizophrenia. His research concentrated on educating relatives concerning the symptoms and the process of the schizophrenia. Also, his research focused on the stabilization of social authority and on the improvement in handling of the family members among themselves. Finally, Andersons research included more effective stress management techniques. In the present study Andersons Psychoeducati on has been used as an intervention.

4. Rationale for the Study

A number of studies ( Holzemer , Human., Aurudo., and others(2007). Greff., Uys ., and others(2009)) have reported on Stigma in PLWHA but very few studies (LiL., Liang , Wu S., and others(2010) have used intervention to reduce the factor of stigma. Minrie, Greff., Leana, Uys (2009) said that, in the absence of any intervention to address and reduce stigma, individuals will continue to report poorer quality of life. Brown, Trujillo and Macintyre (2001) suggest that AIDS stigma can be reduced through intervention strategies including information, counseling, coping skills and acquisition, and contact with affected groups. The reason for using Psycho-education group intervention is because of the short duration which has a long-term effect on

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coping methods. The group model is applicable because of its cost-effectiveness and also because the interaction of patients within the group provides a significant source of emotional support.

5. Method
5.1 Objective
To study the effect of Psycho-education on Stigma in people living with HIV/AIDS.

5.2 Hypotheses
1. 2. H1: H2: Psycho-education will reduce Stigma in PLWHA. There is a significant difference in men and women in rate of reduction of stigma.

5.3 Participants
The study sample consists of 120 PLWHA between the ages of 20-40 years who has registered in ART centre, KR Hospital Mysore. Stigma scale was administered to a large group and selected only 120 PLWHA, who have high score on stigma scale. Participants should not have any other disease like TB, STD and the like rather than HIV.

5.4 Instruments
1. Personal information schedule (PIS): This was been developed by investigator and it includes identification data, socio economic status, etc 2. HIV Stigma scale: This scale is developed by Barbara Berger in 1996. It consists of 40 items with four factors - personalized stigma, disclosure concerns, negative self image, and concern with public attitudes toward people living with HIV. Construct validity was supported by relationships with related constructs: self-esteem, depression, social support, and social conflict. Coefficient alphas are between .90 and .93 for subscales and .96 for the 40-item. Instrument provided evidence of internal consistency reliability. According to Berger the HIV Stigma Scale is reliable and valid with a large, diverse sample of people living with HIV. According to author of this sale psychometric properties of the scale are found to be satisfactory.

5.5 Design
Pre- post experimental design: primarily for the purpose of comparing groups and/or measuring change resulting from experimental treatment and in which one or more experimental groups are exposed to a treatment or intervention and then compared to one or more control groups who did not receive the treatment.

5.6 Procedure
Ethical consideration : Permission was obtained by the University of Mysore and Institutional Human Ethical Committee (IHEC), University of Mysore, to conduct the research study on human beings and use psycho-education intervention. Consent form: NACO standard consent form was used to take consent from PLWHA The study was carried out in three phases: o Phase1: Equating the two groups and Pretest o Phase2: Intervention o Phase3: Post test and follow up

Phase 1: Equating the two groups and Pretest administration The scale was administered to a large group approximately 300 PLWHA. Only 120 PLWHA were selected who have high score on stigma scale. The participants were divided into two groups i.e. experimental group and control group. Selected participants were asked for written informed consent to participate in the study. Experimental group further randomly divided into four groups; each group consists of 15 subjects. Each sub group was given six sessions for 60-min about duration of a week. Control group was kept under observation. Details of Sessions No. Of Groups 4 Group Size 15 No. of sessions 6 Session duration 60 min Session interval 1 week Total duration 6 hours

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Phase 2: Intervention Psycho-education refers to the education offered to people who live with a psychological disturbance. Psychoeducation is not a treatment. It is designed to be part of an overall treatment plan. Psycho-education has been around for a long time. It has remained consistently popular as a tool for families and caregivers to be able to make sense of what is happening to a person who is experiencing a mental disturbance. The concept consists of four elements: Briefing the patients about their illness Problem solving training Communication training Self-assertiveness training The Psycho-education was done in six sessions for experimental group. The intervention sessions abstract is as follows. Session 1: Rapport building was done by introducing myself and making participants to introduce each other and had a casual talk. Presented the game out of the box thinking as an icebreaker and to showcase different perceptions. Before briefing the group about HIV causes, symptom and treatment, experimenter tried to collect information what they know about HIV. Participants were asked some questions like; What is HIV? How it is transmitted? What are the symptoms? Dos and Donts? It was an exchange of thoughts on what they know and experienced being HIV. After the discussions on HIV researcher tried to remove the misconceptions by educating them on HIV through lecture and ppt slides. Gave them complete confidence of keeping things confidential and anonymous. Session 2: Negative emotions were reduced by giving motivational quotes and telling inspiring stories of great personalities who undergone incurable diseases to the subjects. To fill hope and inspiration to live with all distress and disharmony they were given talk on motivational quotes by Vivekananda, Ramakrishna Paramahamsa (spiritual leaders). They were told story about Veenadhari, Ramakrishna Paramahamsa. Session 3: Highlighted about the harm and danger of stigma and discrimination through role play on fear about disclosing HIV, ignoring stigmatizes, avoiding situations and the like. Two skits were played by a group of girls before PLWHA. One skit was on stigma and its danger another role play was on discrimination. At the end PLWHA were made to discuss on role plays, it was an open discussion. Session 4: Provided education on relevant rights and laws on HIV stigma and discrimination. NACO/KSAPS role in legal literacy and make the participants to become familiar with legal information and facilities available. First they were asked whether they are aware of any legal information on HIV stigma and discrimination. Later they were provided information on sources of law and law related to discrimination like article 14, 15, 16 which is a fundamental law. Information on consent and confidentiality were also given talk on .Toll free number of HIV legal service centre was provided to ask any queries . KSAPS plan of legal service centres on all ART centres i.e., 41 centres in 30 districts information was also given. Session 5: Self assertiveness training was provided. First they were told the difference between an assertive person and non assertive person. Given some tips to help build, boost, and develop self-confidence and assertiveness. Assertive Techniques 1. Broken Record - Be persistent and keep saying what you want over and over again without getting angry, irritated, or loud. Stick to your point. 2. Free Information - Learn to listen to the other person and follow-up on free information people offer about themselves. This free information gives you something to talk about. 3. Self-Disclosure - Assertively disclose information about yourself - how you think, feel, and react to the other person's information. This gives the other person information about you. 4. Fogging - An assertive coping skill is dealing with criticism. Do not deny any criticism and do not counterattack with criticism of your own. Make the group open minded, self confident. Session 6: Suggestions were given to improve quality of life by giving talk on practicing healthy habits like exercise, meditation, walking, and positive thinking. Role of diet and nutrition in the management of PLWHA were provided like meal plan, what to eat and what to avoid. Uses of pranayama and meditation and yoga were also told. Some of the exercise postures were shown through slides to practice All this was done to boost

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participants to manage with their symptoms and live with hope. Finally gave summary on overall sessions based on observations and also took feedback. Phase 3: Post test and follow up After one week of last session of intervention, Stigma scale was administered once again for both the groups. The same intervention was given to the control group also from ethical point of view.

6. Data Analysis

In order to test the hypotheses, a computer based SPSS package was used to analyze the data. The t test was used to equate the groups and General Linear Model- repeated measures of ANOVA were utilized to find out the significance of variance within-subjects group effects and between-subjects group effects.

6.1 Results and Discussion

Table No.1: Mean and S.D. of pre-test and post-test scores on Personalized stigma of men and women of both experimental and control groups. GROUP GENDER MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL PRETEST MEAN SD 58.30 6.819 59.77 5.049 59.03 5.994 59.10 6.025 60.43 5.482 59.77 5.750 58.70 6.392 60.10 5.236 59.40 5.860 POSTTEST MEAN SD 39.23 5.063 38.10 5.095 38.67 5.068 58.30 5.596 61.03 5.346 59.67 5.599 48.77 10.974 49.57 12.670 49.17 11.809 CHANGE 19.07 21.67 20.36 0.8 0.6 0.1 9.93 10.53 10.23

EXPERIMENTAL

CONTROL

TOTAL

In personalized Stigma scores, Repeated Measures of ANOVA revealed a significant decrease from pre to post test situation irrespective of the groups. F value 230.413 was found to be highly significant (p = .000). Irrespective of the groups in pre-test, the mean Personalized Stigma score was 59.03 is reduced to 38.67 with the reduction of 20.36 scores which found to be significant. When reduction in the Personalized Stigma scores with reference to groups are concerned again a significant F value was observed (F=225.932; p = .000) indicating a differential decrease for experimental and control groups. From mean values it is evident that experimental group had a reduction of 20.36 scores (from 59.03 to 38.67), whereas control group had reduction of only 0.1 scores (from 59.77 to 59.67). So the decrease in the personalized Stigma has basically in the experimental group which can be attributed to the effectiveness of Psycho-education. However the interactions between gender with respect to change in the scores and gender with respect to groups and change in scores were found to be nonsignificant. In between-subjects effects between groups (irrespective of conditions) together significant difference were observed (F = 201.349; p = .000). However gender wise and interaction between groups and gender was found to be non-significant. Table No.2: Mean and S.D. of pre-test and post-test scores on Disclosure concern of men and women of both experimental and control groups. GROUP GENDER MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL PRETEST MEAN SD 32.60 3.766 32.00 3.572 32.30 3.651 32.40 3.701 32.70 3.771 32.55 3.707 32.50 3.703 32.35 3.658 32.42 3.666 POSTTEST MEAN SD 30.30 3.852 30.70 4.001 30.50 3.899 32.30 2.793 32.30 4.044 32.30 3.446 31.30 3.485 31.50 4.069 31.40 3.774 CHANGE 2.3 1.3 1.8 0.1 0.4 0.22 1.2 0.85 1.02

EXPERIMENTAL

CONTROL

TOTAL

In Disclosure concern scores, Repeated Measures of ANOVA revealed a significant decrease from pre to post test situation irrespective of the groups. F value 5.493 was found to be non significant (p = .021). Irrespective ISSN: 2277-6168 January|2013 www.ijsst.com Page | 6

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of the groups in pre-test, the mean Disclosure concern score was 32.42 is reduced to 31.40 with the reduction of 1.02 scores which found to be significant. When reduction in the Disclosure concern scores with reference to groups are concerned again a significant F value was observed (F=3 .140; p = .079) indicating a differential decrease for experimental and control groups. From mean values it is evident that experimental group had a reduction of 1.8scores (from 32.30 to 30.50), where as control group had reduction of only 0.22 scores (from 32.55 to 32.30 ). So the decrease in the Disclosure concern has basically in the experimental group which can be attributed to the effectiveness of Psycho-education. However the interactions between gender with respect to change in the scores and gender with respect to groups and change in scores were found to be non-significant. In between-subjects effects between groups (irrespective of conditions) together significant difference were not observed (F = 3.943; p = .049). However gender wise and interaction between groups and gender was found to be non-significant. Table No.3: Mean and S.D. of pre-test and post-test scores on Negative self image of men and women of both experimental and control groups. GROUP GENDER MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL PRETEST MEAN SD 38.77 7.224 38.77 7.104 38.77 7.103 37.37 7.252 37.67 6.504 37.52 6.831 38.07 7.211 38.22 6.775 38.14 6.967 POSTTEST MEAN SD 30.80 4.536 30.10 3.717 30.45 4.127 36.47 6.595 37.77 6.947 37.12 6.747 33.63 6.298 33.93 6.742 33.78 6.498 CHANGE 7.97 8.67 8.32 0.9 0.1 0.4 4.44 4.29 4.36

EXPERIMENTAL

CONTROL

TOTAL

In Negative self image scores, Repeated Measures of ANOVA revealed a significant decrease from pre to post test situation irrespective of the groups. F value 36.087 was found to be highly significant (p = .000). Irrespective of the groups in pre-test, the mean Negative self image score was 38.14 is reduced to 33.78 with the reduction of 4.36 scores which found to be significant. When reduction in the Negative self image scores with reference to groups are concerned again a significant F value was obser ved (F=29.767; p = .000) indicating a differential decrease for experimental and control groups. From mean values it is evident that experimental group had a reduction of 8.32scores (from 38.77 to 30.45), whereas control group had reduction of only 0.4scores (from 37.52 to 37.12). So the decrease in the Negative self image has basically in the experimental group which can be attributed to the effectiveness of Psycho-education. However the interactions between gender with respect to change in the scores and gender with respect to groups and change in scores were found to be non-significant. In between-subjects effects between groups (irrespective of conditions) together significant difference were not observed (F = 8.920; p = .003). However gender wise and interaction between groups and gender was found to be non-significant. Table No.4: Mean and S.D. of pre-test and post-test scores on public attitudes of men and women of both experimental and control groups. GROUP GENDER MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL PRETEST MEAN SD 64.70 4.458 64.70 4.822 64.70 4.604 63.67 4.221 64.23 4.493 63.95 4.331 64.18 4.335 64.47 4.627 64.33 4.467 POSTTEST MEAN SD 48.90 4.730 48.37 4.311 48.63 4.495 61.90 2.510 63.13 4.208 62.52 3.491 55.40 7.554 55.75 8.560 55.58 8.041 CHANGE 15.8 16.33 16.07 1.77 1.1 1.43 8.78 8.72 8.75

EXPERIMENTAL

CONTROL

TOTAL

In Public attitudes scores, Repeated Measures of ANOVA revealed a significant decrease from pre to post test situation irrespective of the groups. F value 248.686 was found to be highly significant (p = .000). Irrespective ISSN: 2277-6168 January|2013 www.ijsst.com Page | 7

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of the groups in pre-test, the mean Public attitude score was 64.33 is reduced to 55.58 with the reduction of 8.75 scores which found to be significant. When reduction in the Public attitudes scores with reference to groups are concerned again a significant F value was observed (F=173.885; p = .000) indicating a differential decrease for experimental and control groups. From mean values it is evident that experimental group had a reduction of 16.07 (from 64.70 to 48.63), whereas control group had reduction of only 1.1 (from 63.95 to 62.52). So the decrease in the Public attitudes has basically in the experimental group which can be attributed to the effectiveness of Psycho-education. However the interactions between gender with respect to change in the scores and gender with respect to groups and change in scores were found to be non-significant. In between-subjects effects between groups (irrespective of conditions) together significant difference were observed (F = 143.346; p = .000). However gender wise and interaction between groups and gender was found to be non-significant. Table No.5: Mean and S.D. of pre-test and post-test scores on Stigma(Total) of male and female of both experimental and control groups. GROUP EXPERIMENTAL GENDER MALE FEMALE TOTAL MALE FEMALE TOTAL MALE FEMALE TOTAL PRETEST MEAN SD 194.33 19.361 195.60 17.795 194.97 18.447 192.53 17.366 195.03 17.121 193.78 17.144 193.43 18.257 195.32 17.315 194.37 17.742 POSTTEST MEAN SD 149.23 9.786 147.27 9.017 148.25 9.382 188.97 14.852 194.23 16.477 191.60 15.777 169.10 23.598 170.75 27.097 169.93 25.314 CHANGE 45.1 48.33 46.72 3.56 0.8 2.18 24.33 24.57 24.44

CONTROL

TOTAL

In Stigma scores, Repeated Measures of ANOVA revealed a significant decrease from pre to post test situation irrespective of the groups. F value 35868.150 was found to be highly significant (p = .000). Irrespective of the groups in the pre-test, the mean Stigma score was 194.37 is reduced to 169.93 with the reduction of 24.44 scores which found to be significant. When reduction in the Stigma scores with reference to groups are concerned again a significant F value was observed (F=29748.267; p = .000) in dicating a differential decrease for experimental and control groups. From mean values it is evident that experimental group had a reduction of 46.72 scores (from 194.97 to 148.25), whereas control group had reduction of only 2.18 scores (from 193.78 to 191.60). So the decrease in the Stigma has basically in the experimental group which can be attributed to the effectiveness of Psycho-education. However the interactions between gender with respect to change in the scores and gender with respect to groups and change in scores were found to be non-significant. In betweensubjects effects between groups (irrespective of conditions) together significant difference were observed (F = 89.407; p = .000). However gender wise and interaction between groups and gender was found to be nonsignificant. Ever since the first cases of AIDS were reported in the early 1980s, people with HIV have been stigmatized. There are a number of reasons for this: HIV is a serious, life-threatening illness. There is a long history of illnesses being stigmatized, even when such illnesses dont pose a health risk to others, like cancer, or can be prevented and treated, such as tuberculosis (TB). HIV is often transmitted through sex or drug use. Many people make moral judgments about these kinds of behavior. The stigma that is associated with HIV is used to maintain some of the inequalities that already exist in society. The actual denial of equal and fair treatment to people with HIV is a form of discrimination. The overall result indicates that Psycho-education intervention is highly effective in reducing stigma and domains of stigma like Personalized stigma, disclosure concern, negative self image, public attitudes in PLWHA. Sheng Wu, Li Li (2006) in a study saw an effect of a brief intervention which aimed at reducing HIV-related stigma among service providers in China who from four county hospitals in the Yunnan province of China. Brief intervention includes small group activities, including role-plays, games, group discussions, and testimony by an HIV advocate, Results suggest some stigma reduction interventions appear to work, at least on a small scale and in the short term, but many gaps remain especially in relation to scale and duration of impact and in ISSN: 2277-6168 January|2013 www.ijsst.com Page | 8

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terms of gendered impact of stigma reduction interventions. Cognitive behavioral stress management intervention (CBSM) appears to have a significant role to play in the management of HIV spectrum disease. This includes ameliorating distress, improving patient adherence to medical regimens, and facilitating the efforts of HIV-infected women and men to cope effectively with their chronic disease. The results seen was increased quality and quantity of life ( Neil, 2011). Findings of the present study also reports the same of intervention being effect in reducing Stigma. Martinez (2012) findings says that HIV-infected adolescent women experience HIV stigma and poor adherence over time. Factors like health care satisfaction and coping may minimize stigma's effect on medication adherence. Van Hollen (2010) . The result says women tend to be blamed for the spread of HIV/AIDS, and as a result, HIV-positive women face greater stigma and discrimination than HIV-positive men. Findings of the present study support the above studies of intervention being effect in reducing stigma and do not support the differences in gender because there is no differences between the genders in stigma were found. From this study it is evident that the effect of Psycho-education is same irrespective of gender. The experimental group is found to have reduced its Stigma compared to the control group after the Psycho-education intervention.

7. Conclusions
The Psycho-education has made a positive impact on reduction of Stigma and its factors namely, Personalized stigma, disclosure concern, negative self image, Public attitudes in PLWHA. There is no difference between men and women stigma in rate of reduction.

Lakshmi M G, PhD Research Scholar, University of Mysore, Mysore

Dr. Sampathkumar, Assistant Professor, University of Mysore, Mysore

References
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