ResearchPDF Available

Community Champions HIV/AIDS Advocates Mobilization Project Reducing HIV Stigma and Advancing Equity Through Committed Action (2011-2015)

Authors:
  • Regent Park community health centre
  • Toronto Metropolitan University

Abstract and Figures

Background: The Community Champions HIV/AIDS Advocates Mobilization Project (CHAMP) is a community based intervention research study conducted by the Committee for Accessible AIDS Treatment in partnership with five HIV/AIDS service organizations and researchers from health and academic institutions. The goal of the study is to address HIV stigma through collective empowerment, capacity building, and community championship. CHAMP evaluated the effectiveness of two stigma reduction interventions in reducing HIV stigma: (i) Acceptance Commitment Training (ACT) and (ii) Social Justice Capacity Building (SJCB). ACT promotes psychological flexibility through experiential learning whereby individuals become better able to recognize their thoughts as just thoughts, and not getting stuck in thoughts that may restrict or hinder them from fully living. ACT also helps individuals clarify their values and guides them in taking the appropriate actions that align with their values. SJCB promoted collective empowerment through critical dialogue to enhance increased understanding of social justice and health equity. Through collaborative and experiential learning, SJCB enhanced participants' capacity in critical health literacy, systemic advocacy, and community mobilization. Methods: CHAMP engaged engaged PLHIV and non-PLHIV community leaders (CLs) from faith-based, media, arts, and social justice sectors in Asian, Black, and Latino communities in the Greater Toronto Area to participate in the study. Participants were randomly assigned to receive group training in SJCB only or SJCB and ACT. Each intervention consists of 4 half-day training. It was followed by structured reconnection at 3-month and 9-month post-intervention to provide opportunities for participants to share their ideas and experiences of community action after the training. We evaluated the impact of the interventions using mixed methods: focus groups and surveys before the intervention; surveys immediately after the intervention, and a combination of surveys, focus groups, and individual interviews at 9-month post-intervention. In addition, participants submitted monthly activity logs that documented the specific HIV championship and social justice activities they engaged in over nine months after completing the interventions. Results: We recruited and engaged 105 qualified participants. A total of 66 participants completed the interventions and 62 of them completed all research activities at nine months after the interventions. In the focus groups conducted before the interventions, participants identified numerous barriers to addressing HIV in their communities. Social barriers included: low visibility and community interest on HIV; experience of racism that heightens the fear of increased discrimination due to associated stigma of HIV; and intersecting oppressions (e.g., homophobia, sexism, transphobia). These barriers created an unsafe environment for HIV disclosure and reinforced silence, denial, and invisibility of HIV. Personal barriers included: a lack of time and competing life demands (e.g., work, school, immigration/settlement, other social justice work) and worries about not having the knowledge and skills for HIV advocacy. After the interventions, our survey data indicated that PLHIV had reduced self-stigma while Non-PLHIV CLs had reduced stigma against HIV/AIDS. The data also showed that both PLHIV and Non-PLHIV CLs reported an increase in confidence and readiness to speak out and take action to address HIV stigma and social justice. In the focus groups conducted at nine months after the interventions, PLHIV reported increased self-acceptance, readiness to disclose their HIV status, and motivation to engage in HIV advocacy. Non- PLHIV CLs reported increased awareness of HIV stigma and empathy towards PLHIV. Many PLHIV and Non-PLHIV CLs demonstrated an increased understanding of the connection between HIV stigma and other social oppressions (e.g., homophobia, transphobia, sexism, poverty). Most participants in both groups expressed motivation and commitment to champion HIV issues and address social injustice. They identified networking and alliance building as key facilitators to HIV championship. They also aspired to engage in dialogue with other faith leaders on HIV; establish ongoing support for HIV disclosure; and promote HIV championship through social media. The activity logs submitted by participants over a period of nine months after the interventions demonstrated that ACT and SJCB were effective in reducing HIV stigma and promoting HIV and social justice championship. Over the nine month period, the 62 CHAMP participants carried out a total of 1090 championship activities at five levels: personal; interpersonal; organization/community; societal and international/global. These activities also addressed five action areas – championing against HIV related stigma and discrimination; championing against social injustices; promoting care and support of PLHIV; alliance building and community networking; and lastly, promoting empowerment and resilience. Conclusion: HIV stigma is a big obstacle to effective HIV responses in all communities. Furthermore, the negative impact of HIV stigma is reinforced by intersecting oppressions such as racism, homophobia, sexism, and economic marginalization experienced by ethno-racial minority and newcomer communities. CHAMP has successfully demonstrated that HIV stigma can be reduced through interventions that combine the use of intrapersonal and interpersonal psychological strategies (ACT) and interpersonal and collective empowerment strategies (SJCB). The use of mixed methods is critical in documenting the effectiveness and outcomes of complex intervention research. In CHAMP, we went beyond using focus groups and surveys to study the effectiveness of SJCB and ACT. We used field notes to capture how different experiential learning activities in ACT and SJCB influenced participants’ perceptions and attitudes. Furthermore, the monthly championship activity logs submitted by the participants enabled us to demonstrate the effects of ACT and SJCB in influencing participants’ attitudes, behaviors and actions. Cross-sector (HIV, faith, media, social justice, health) and cross-cultural (African/Caribbean, Asian, Latino) engagement and collaboration is effective in addressing gaps in HIV responses, research, and policy in ethno-racial minority and newcomer communities.
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Design: Aries Cheung at TransMedia9
465 Dundas Street East
Toronto, ON M5A 2B2
416-364-2261 ext 2277
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Facebook.com/HIVImmigration
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Graphic Design: Aries Cheung at TransMedia9
Community
Champions
HIV/AIDS
Advocates
Mobilization
Project
Reducing HIV Stigma
and Advancing
Equity Through
Committed Action
Research Report
C
H
A
M
P
1
ACKNOWLEDGEMENTS
Our heartfelt appreciation and thanks to:
Our participants for their commitment, time, and sharing of their life-experiences.
Their collective commitment contributed to furthering our understanding and
eorts in advancing HIV stigma reduction.
Our Project Advisory Committee for their guidance and advice towards research
design, outreach and recruitment strategies, and post-intervention activities: Akim
Adé Larcher, Habeeb Ali, Rose-Anne Bailey, Andrew Campbell, Morris Komakech,
Thomas Mbugua, Natalie Wood, Carly Yoshida-Butryn, Vijaya Chikermane, Radha
Bhardwaj, Samuel Lopez, Rai Reece, Christopher Hoover, and Avvy Go.
Our CHAMP research team:
Principal Investigators: Alan Tai-Wai Li (Nominated Principal Investigator, Regent
Park Community Health Centre & Committee for Accessible AIDS Treatment);
Josephine Pui- Hing Wong (Co-Principal Investigator, Ryerson University); Kenneth
Fung (Co-Principal Investigator, University of Toronto & University Health Network).
Co-Investigators: Omer Abulghani (Alliance for South Asian AIDS Prevention);
Jack Kapac (University of Windsor); Rene Lopez (Centre for Spanish Speaking
Peoples); Eleanor Maticka-Tyndale (University of Windsor); James Murray (AIDS
Bureau, Ontario Ministry of Health and Long Term Care); Fanta Ongoiba (Africans
in Partnership Against AIDS); Shannon Ryan (Black Coalition AIDS Prevention);
Richard Utama (Asian Community AIDS Services); Mateusz Zurowski (University
Health Network).
Our sta team: Research Project Coordinator, Henry Luyombya; Peer Research
Associates: Alessandro Ciro Bisignano; Christian Hui; Dale Maitland; Kenneth Poon;
Francisco Corroy (2011-2012); and Amanuel Tesfamichael (2013 – 2014).
This project is funded by the Canadian Institute of Health Research (CIHR) HIV/AIDS
Community-Based Research Program.
Special thanks to Regent Park Community Health Centre and the Ontario HIV
Treatment Network for their administrative and technical support.
Graphic Design: Aries Cheung
Copy Editing: Ray Garcia
2
TABLE OF CONTENTS
Acknowledgements -------------------------------------------------------------------------------- 1
Committee for Accessible AIDS Treatment --------------------------------------------------- 3
Executive Summary -------------------------------------------------------------------------------- 4
Introduction and Background ------------------------------------------------------------------- 6
The CHAMP research study: design and implementation ------------------------------ 8
Results
1. CHAMP Participants ----------------------------------------------------------------------- 10
2. Participants’ Perspectives Before the Interventions
2.1 Key challenges --------------------------------------------------------------------- 12
2.2 Personal motivators for getting involved in HIV work ------------------ 13
2.3 Personal barriers for getting involved in HIV work ------------------- 13
2.4 Potential strategies and opportunities for HIV work ------------------- 14
3. Participants’ Perspectives After the Interventions
3.1 Survey results ---------------------------------------------------------------------- 15
3.2 Focus group and Individual interview results -----------------------------17
3.3 Results from monthly activity logs -------------------------------------------- 21
Discussion and Reection
zCHAMP eectiveness in reducing HIV stigma ------------------------------------------ 27
zInnovative research designs and impact ----------------------------------------------- 28
Recomendations ----------------------------------------------------------------------------------- 30
3
COMMITTEE FOR ACCESSIBLE AIDS TREATMENT CAAT
Mission
The Committee for Accessible AIDS Treatment (CAAT)
is a coalition of aected individuals and organizations
from the legal, health, settlement, social service, and
HIV/AIDS sectors. CAAT is committed to promoting the
health and well-being of people living with HIV (PLHIV)
who face access barriers related to their precarious
status in Canada.
Brief History
Formed in 1999 to improve treatment and service
access for marginalized PLHIV, CAAT has been at the
forefront of education, research, service coordination,
and advocacy on issues related to HIV/AIDS. In 2001,
CAAT undertook a ground-breaking collaborative
community-based action research project: Improving
treatment access for PLHIV who are immigrants, refugees,
and non-status. The study documented the challenges
faced by vulnerable PLHIV groups and engaged
stakeholders from various sectors to develop a joint
action plan to address these challenges. As a result of
the study, several innovative initiatives were developed
that continue to this day.
Vision
Our vision is a healthy urban community in which all
individuals living with HIV/AIDS have the information
and tools they need to access health, social, and legal
services that are inclusive and respectful regardless of
their immigration status.
Values and Guiding Principles
We place the highest value on the voices and leadership
of PLHIV in our work. We strongly believe that health
is holistic and is inuenced by the physical, emotional,
sexual, and spiritual aspects of life.
Equity and Social Justice
We value a human rights based approach that
promotes access to HIV treatment and health care.
This approach respects individuals’ rights to access
sexual and reproductive health services regardless of
their HIV status or immigration status. It also embraces
diversity and respects the voices of all stakeholders.
We are committed to social justice for all. CAAT works
from an anti-oppression, anti-racism, anti-homophobia/
transphobia, and anti-sexism framework. We aim to
reduce discrimination, stigma, and prejudice based
on: culture, ethnicity, religion, age, ability, sexual
orientation, and HIV status.
Community Ownership /
Responsiveness
We place great value on community and evidence-
based advocacy and solutions to aect change in social
structures and policy. At CAAT, we also emphasize
community ownership, transparency, accountability,
and meaningful collaboration with the communities we
serve.
CAAT’s Key Program Areas
1. Empowerment Education and Outreach
2. Community Development and Capacity Building
3. Service Coordination and Planning
4. Community-Based Research and Evidence-Based
Advocacy
4
EXECUTIVE SUMMARY
The CHAMP Study
zThe Community Champions HIV/AIDS Advocates
Mobilization Project (CHAMP) is a community-
based intervention research study conducted by
the Committee for Accessible AIDS Treatment in
partnership with ve HIV/AIDS service organizations
and researchers from health and academic
institutions. The goal of the study is to address HIV
stigma through collective empowerment, capacity
building, and community championship.
zCHAMP evaluated the eectiveness of two stigma-
reduction interventions study in reducing HIV
stigma: Acceptance Commitment Training (ACT) and
Social Justice Capacity Building (SJCB).
zACT promoted psychological exibility through
experiential learning. That is, individuals were better
able to face their thoughts as just thoughts. This
allowed them to move past thoughts that may
restrict or hinder them; psychological exibility also
helps individuals clarify their values and guides them
in taking the appropriate actions.
zSJCB promoted collective empowerment through
critical dialogue, increased understanding of social
justice, and health equity; through collaborative
and experiential learning, SJCB enhanced individual
capacity in critical health literacy, systemic advocacy,
and community mobilization.
How We Conducted CHAMP
zWe engaged PLHIV and non-PLHIV community
leaders (CLs) from faith-based, media, arts, and
social justice sectors in Asian, Black, and Latino
communities in the Greater Toronto Area to
participate in the study.
zParticipants were randomly assigned to receive
group training in SJCB or SJCB+ACT.
zWe evaluated the impact of the interventions
through data collected right before and after
the interventions. This was followed by another
evaluation after three and nine months. We used
a combination of questionnaires, focus groups,
and individual interviews. In addition, participants
submitted activity logs that documented the specic
HIV championship activities they engaged in over
nine months after completing the interventions.
What We Found
zWe recruited and engaged 105 qualied
participants. A total of 66 participants completed the
interventions and 62 of them completed all research
activities at nine months after the interventions.
zIn the focus groups conducted before the
interventions, participants identied numerous
barriers to addressing HIV in their communities.
Social barriers included: low visibility and
community interest on HIV; experience of racism
that heightens the fear of increased discrimination
due to associated stigma of HIV; and intersecting
oppressions (e.g., homophobia, sexism, transphobia).
These barriers created an unsafe environment for
HIV disclosure and reinforced silence, denial, and
invisibility of HIV. Personal barriers included: a lack of
time and competing life demands (e.g., work, school,
immigration/settlement, other social justice work)
and worries about not having the knowledge and
skills for HIV advocacy.
zAfter the interventions, our survey data indicated
that PLHIV had reduced self-stigma while Non-PLHIV
CLs had reduced stigma against HIV/AIDS. The data
also showed that both PLHIV and Non-PLHIV CLs
reported an increase in condence and readiness to
speak out and take action to address HIV stigma and
social injustice.
5
zIn the focus groups conducted at nine months after
the interventions, PLHIV reported increased self-
acceptance, readiness to disclose their HIV status,
and motivation to engage in HIV advocacy; Non-
PLHIV CLs reported increased awareness of HIV
stigma and empathy towards PLHIV. Many PLHIV
and Non-PLHIV CLs demonstrated an increased
understanding of the connection between
HIV stigma and other social oppressions (e.g.,
homophobia, transphobia, sexism, poverty). Most
participants in both groups expressed motivation
and commitment to champion HIV issues and
address social injustice. They identied networking
and alliance building as key facilitators to HIV
championship. They also aspired to engage in
dialogue with other faith leaders on HIV; establish
ongoing support for HIV disclosure; and promote HIV
championship through social media.
zThe activity logs submitted by participants over
a period of nine months after the interventions
demonstrated that ACT and SJCB were eective in
reducing HIV stigma and promoting HIV and social
justice championship. Over the nine month period,
the 62 CHAMP participants carried out a total of
1090 championship activities at ve levels: personal;
interpersonal; organization/community; societal and
international/global. These activities also addressed
ve action areas – championing against HIV related
stigma and discrimination; championing against
social injustices; promoting care and support of
PLHIV; alliance building and community networking;
and lastly, promoting empowerment and resilience.
What We Learned
zHIV stigma is a big obstacle to eective HIV
responses in all communities. Furthermore,
the negative impact of HIV stigma is reinforced
by intersecting oppressions such as racism,
homophobia, sexism, and economic marginalization
experienced by ethno-racial minority and newcomer
communities.
zCHAMP has successfully demonstrated that HIV
stigma can be reduced through interventions that
combine the use of intrapersonal/psychological
strategies (ACT) and interpersonal/collective
empowerment strategies (SJCB).
zThe use of mixed methods is critical in documenting
the eectiveness and outcomes of complex
intervention research. In CHAMP, we went beyond
using focus groups and surveys to study the
eectiveness of SJCB and ACT. We used eld notes
to capture how dierent experiential learning
activities in ACT and SJCB inuenced participants’
perceptions and attitudes. Furthermore, the monthly
championship activity logs submitted by the
participants enabled us to demonstrate the eects of
ACT and SJCB in inuencing participants’ attitudes,
behaviors, and actions.
zCross-sector (HIV, faith, media, social justice, health)
and cross-cultural (African/Caribbean, Asian,
Latino) engagement and collaboration is eective
in addressing gaps in HIV responses, research, and
policy in ethno-racial minority and newcomer
communities.
6
INTRODUCTION AND BACKGROUND
Community Needs: Ethno-racial
minority communities and HIV
zEthno-racial minority communities experience
higher rates of HIV infection than the general
Canadian population. In 2011, Canadian data
shows that ethno-racial minority newcomers from
endemic countries accounted for about 16.9% of
new HIV infections while making up only 2.2% of the
Canadian population. 1
zThe elevated risks of HIV in ethno-racial minority and
newcomer communities are associated with complex
factors. These factors include the lack of access
to culturally and linguistically inclusive services,
stressors related to migration and settlement, and
experiences of intersecting discrimination (such
as homophobia, racism, sexism and poverty). In
addition, evidence from AIDS service organizations
and research studies have shown that HIV
stigma creates unsafe environments that impede
community eorts in HIV prevention, testing,
disclosure, and access to treatment and care.
Development of CHAMP:
Stigma undermines
prevention and care
zThe Community Champions HIV/
AIDS Advocates Mobilization Project
(CHAMP) study was designed based
on ndings from the Mobilizing
Ethno-racial Leaders Against Stigma
(MEL) study conducted by CAAT in
2009. The MEL study was the rst
local study that engaged PLHIV
along with faith-based, media, and
social justice leaders in the Greater
Toronto Area in meaningful dialogue
to explore barriers and opportunities
to reduce HIV stigma.
zMEL study participants identied that sex-negative
values, deep-rooted homophobia, and HIV/AIDS
phobia creates hostile social environments that
make it unsafe for PLHIV to disclose their status, seek
support, or advocate for services and social changes.
The lack of visible PLHIV presence and leadership
and the lack of community leaders to champion HIV
issues within ethno-racial minority communities
reinforce community denial and silence about the
true impact of HIV. This in turn heightens HIV stigma
and creates a vicious cycle of stigma, invisibility,
denial, and lack of eorts to champion HIV issues
amongst ethno-racial minority communities.
zCHAMP is a follow-up community-based intervention
study based on recommendations from the MEL
study. These recommendations were co-developed
with community stakeholders at three MEL
knowledge translation forums attended by PLHIV,
service providers, policy-makers, and researchers.
1 Public Health Agency of Canada. (2015), Population-Specic HIV/AIDS Status Reports – People Living with HIV/AIDS, Public Health Agency
of Canada, Ottawa, available at:
http://www.phac-aspc.gc.ca/aids-sida/publication/ps-pd/people-personnes/index-eng.php
(Accessed 14 August 2015).
7
Study Purposes
zCHAMP was a community-based intervention
study that evaluated the eectiveness of two
interventions in reducing HIV stigma and mobilizing
HIV champions in the African/Caribbean, Asian, and
Latino communities in the Greater Toronto Area.
zCHAMP specically targeted and engaged PLHIV and
non-PLHIV community leaders (CL) from the faith-
based, media, and social justice sectors; these leaders
were identied as playing critical roles in providing
information and support on health, settlement, and
other social care needs pertinent to ethno-racial
minority communities.
zThe two stigma-reduction interventions CHAMP
piloted and evaluated were:
{Acceptance and Commitment Training (ACT)
{Social Justice Capacity Building (SJCB)
The Stigma-reduction Interventions
zAcceptance and Commitment Training is a training
model designed to increase psychological exibility
to deal with internal fears, oppressions, and stigma.
{ACT promotes acceptance of one’s own thoughts
and feelings, including unwanted and unpleasant
ones; supports participants to focus on what
really matters to them based on their core values
and take action towards realizing their valued life
goals.
{The model uses a variety of experiential learning
strategies to enhance six core psychological
processes: present moment, self-as-context,
defusion, acceptance, values, and committed
action. These processes also strengthen self-
compassion and compassion towards others.
Research evidence shows that ACT is eective in
addressing stigma associated with mental illness,
racism, and substance use. 2,3,4
zSocial Justice Capacity Building is a training model
that promotes critical understanding of social justice
and equity in addition to skills development in
advocacy and community mobilization.
{SJCB aims to reveal inequitable power relations in
society and identify social determinants of health
disparities experienced by ethno-racial minority
and newcomer communities. SJCB uses dialogue
and critical reection to promote individual and
collective empowerment.
{The model uses a collaborative learning approach
that taps into participants’ lived experiences
and community strengths. Learning activities
include experiential exercises on social inclusion/
exclusion, sharing of resistance strategies, critical
dialogues on intersecting social oppressions, and
engagement in developing collective strategies
to address HIV related stigma and other social
inequities. Empowerment education like SJCB
has been used widely in the social service
and advocacy sector but its use in HIV stigma
reduction has not been evaluated.
Our Research Questions
In the CHAMP study, we aim to answer the following
research questions:
zWill SJCB reduce HIV stigma and enhance
empowerment, anti-oppressive attitudes/intentions,
and activism among PLHIV and CLs?
zWill ACT increase psychological exibility and reduce
HIV stigma?
zWill the combination of ACT+SJCB compared to only
SJCB lead to a greater reduction in HIV stigma and
greater empowerment, anti-oppressive attitudes/
intentions, and activism among PLHIV and non-
PLHIV CLs?
THE CHAMP RESEARCH STUDY
2 Masuda, A., Hayes, S. C., Fletcher, L. B., Seignourel, P. J., Bunting, K., Herbst, S. A., . . . Lillis, J. (2007). Impact of acceptance and commitment
therapy versus education on stigma toward people with psychological disorders. Behaviour Research and erapy, 45(11), 2764-2772.
doi:10.1016/j.brat.2007.05.008
3 Lillis, J., & Hayes, S. C. (2007). Applying acceptance, mindfulness, and values to the reduction of prejudice: A pilot study. Behavior Modication,
31(4), 389-411. doi:10.1177/0145445506298413
4 Lee, E. B., An, W., Levin, M. E., & Twohig, M. P. (2015). An initial meta-analysis of acceptance and commitment therapy for treating substance
use disorders. Drug and Alcohol Dependence, doi:10.1016/j.drugalcdep.2015.08.004
8
Our goal was to recruit 60 participants. To evaluate the
eectiveness of SJCB as a stand-alone intervention and
SJCB in combination with ACT, we randomly assigned
participants to one of two intervention groups.
CHAMP participation criteria were as follows:
zParticipants were 18 years or older, living in the
Greater Toronto Area and self-identied as a member
of the African/Caribbean, Asian, and Latino Canadian
communities.
zPLHIV participants had limited prior leadership roles
in the HIV sector in order to maximize opportunities
for new leadership development in the PLHIV
communities.
zNon-PLHIV CL participants were aliated with faith-
based, media, and social justice organizations to
maximize opportunities for institutional impact.
Recruitment
zAt the start of the CHAMP study, we built a strong
partnership with community organizations in the
HIV/AIDS, settlement services and legal/social justice
sectors. We also established a project advisory
committee with members from faith-based, social
justice, and media sectors along with a network of
community key informants. These partners and
collaborators provided us with advice and support
for successful recruitment.
THE CHAMP STUDY: DESIGNS AND IMPLEMENTATION
Theoretical Framework
The CHAMP study was guided by the:
zPopulation health promotion framework which is
grounded on principles of social justice and health
equity.5 It recognizes that:
{Individual and collective health are connected.
{Health disparities are the outcomes of social
inequities (e.g., racism, economic marginalization,
stigma, and discrimination).
{Eective responses to HIV/AIDS must be
supported by inclusive public policy, equitable
resource distribution, and supportive
environments at all levels.
zCommunity empowerment, GIPA/MIPA6, and
capacity building approaches7 that are based on:
{Social action processes that promote the
meaningful participation of aected communities.
{Critical dialogue and collaborative learning
that honor lived experiences and processes
that increase individual and community self-
determination, control, and their collective
capacity to respond to HIV and related social
concerns.
Research Design
To evaluate the eectiveness of ACT and SJCB in
reducing self-stigma (felt stigma) and social stigma
(enacted stigma), we specically engaged two
participant populations in the African/Caribbean, Asian,
and Latino communities:
(i) People living with HIV
(ii) Non-PLHIV community leaders (CLs) from faith-
based, social justice organizations and ethno-specic
media
5 Anderson, J. M., Rodney, P., Reimer-Kirkham, S., Browne, A., Khan, K. B., & Lynam, M. J. (2009). Inequities in health and healthcare viewed
through the ethical lens of critical social justice: Contextual knowledge for the global priorities ahead. Advances in Nursing Science, 32(4), 282-
294. doi: doi: 10.1097/ANS.0b013e3181bd69556 GIPA/MIPA refers to greater involvement of people living with HIV/AIDS and meaningful
involvement of people living with HIV/AIDS.7 Laverack, G. (2005). Public health: Power, empowerment and professional practice. New York:
Palgrave Macmillan.-
6 GIPA/MIPA refers to greater involvement of people living with HIV/AIDS and meaningful involvement of people living with HIV/AIDS.
7 Laverack, G. (2005). Public health: Power, empowerment and professional practice. New York: Palgrave Macmillan.
Recruitment goal: N=60
PLHIV (n= 30) Non-PLHIV CL (n=30)
SJCB only
(n=15)
SJCB+ACT
(n=15)
SJCB only
(n=15)
SJCB+ACT
(n=15)
9
zThe CHAMP participants were recruited through
a database of over 300 people generated through
multiple outreach and promotion strategies. These
strategies included: promotion via peer-based
networks amongst ethno-racial AIDS service
organizations (who were collaborators of the study);
media promotion through both mainstream and
ethno-specic outlets; and community service
agency postings.
zSince CHAMP required substantial time
commitments over a period of 10 months, we
anticipated a potential drop-out rate of 30-40%.
Thus, we recruited extra participants to ensure that
we reached our study goal of 60 participants.
Before data collection, we obtained research ethics
approvals from all our aliated universities and
informed consent from our participants. We used both
quantitative and qualitative methods to answer our
research questions.
zThe SJCB and the ACT interventions each consisted
of four half-day sessions. In addition, participants
were invited to attend two networking sessions at
three and nine months after the interventions. Field
notes of salient issues were taken during debrieng
after each training and reconnection session.
Interv.
Groups Participants Pre- Interv.
measures
Interv.
ACT
Immed.
Post-
Interv.
SJCB
Immed.
Post-
Activity
Logs
x 9
months
3 month
post-
9 month
post-
ACT +
SJCB
PLHIV
Focus Goups
Socio-
demo. Survey
ACT &
SJCB Eval.
measures
XSJCB
measures XJCB
measures X
• Structured
networking
session
• ACT + SJCB
measures
• Structured
networking
session
• ACT + SJCB
measures
• Focus
Groups
• Individual
interviews
Non-PLHIV
SJCB
Only
PLHIV
XACT + SJCB
Measures X
Non-PLHIV
Intervention Design Flow Chart
TIME
zWe invited all the participants to complete a survey
before, immediately after, and nine months after the
interventions.
zWe also invited all the participants to take part in a
focus group discussion before and nine months after
the interventions.
zOver the nine months following the interventions,
we invited the participants to submit monthly logs
to capture their community engagement, advocacy,
and HIV stigma reduction activities.
Study Implementation: Interventions and Data Collection
10
PLHIV
Total 35
Born in Canada
Yes
CL
Total 31
35 25
0
6
No
No
Yes
PLHIV
Total 35
Immigration
Status
CL
Total 31
Citizen
15
Others
6
PR
14
Citizen
23
Others
5
PR3
Used ASO Services
Total 35
Used Services (PLHIV)
27
13
8
22
Used Non-ASO Services
Total 35
No
No
Yes
Yes
PLHIV
Total 35
Education
CL
Total 31
Graduate degree
Less than High School
High School
Post-Secondary i.e.
Apprentice, College,
University Undergrad
20
9 4
20 17
4 10
RESULTS
1. CHAMP Participants
zWe recruited and engaged 105 qualied participants
(63 PLHIV and 42 non-PLHIV CLs) who were willing
and able to participate in the study.
zA total of 66 participants (35 PLHIV and 31 Non-
PLHIV CLs) completed the intervention trainings.
Reasons for dropping out during the interventions
included: competing time demands related to work,
school, and health related issues.
CHAMP Participants
ACT + SJCB SJCB Only Total
PLHIV 16 19 35
CL 15 16 31
Total 31 35 66
A total of 62 participants (32 PLHIV and 30 Non-PLHIV
CLs) completed all research activities and end of project
data collection at nine months after the interventions.
Reasons for attrition during the follow-up period were:
migration to another country (n=2), deportation (n=1),
and death due to non-HIV related illness (n=1).
11
PLHIV
Total 35
<1 1-5 6-10 11-15 16-20 21-30 31+ Years
Years in Canada
CL
Total 31
6
1
6
5
8
6
7
6
3
1
2
1
3
5
Sexual Orientation
CL
Total 31
18
24
1
11
22
17
Heterosexual
Questioning Bisexual
Gay/Lesbian
CL
Total 31
Media
6
Faith
12
Social
Justice
13
Community Leaders
by Sector
PLHIV
Total 35
Female
Gender
Male
Trans
CL
Total 31
18 12
16 19
1 0
PLHIV
Total 35
50-59
60+
20-29
19+
Years Age
30-39
40-49
CL
Total 31
12 8
12 3
69
23
3
0
6
2
PLHIV Total 35
CL Total 31
Ethnicity
Asian
7
Latino
8
Black
20 Asian
18
Latino
3
Black
10
PLHIV
Total 35
Faith
CL
Total 31
Christian
22
Christian
15
Hindu
1
Hindu
0
Buddhist
2
Buddhist
1
Muslim
0
Muslim
4
None
7
None
29
Other
3
Other
2
12
e priest will
come out and say, “Being HIV+ is
punishment by god because you are gay. You
don’t follow the 10 commandments… it is why
you are gay.” So how am I going to be a member of a
church and listening to things against me? is is my
humanity, my moral… what about me? at is why
most of us don’t go to church. Because [the Church]
is a powerful institution, it is like we are just tiny
particles ghting against big power.
(Latino man, PLHIV, ACT + SJCB)
[HIV] is a taboo nobody talks about; it is a real stigma.
When I mentioned that I am coming to this volunteer
project, people looked at me: “Why would you do that?
at doesn’t apply to you.” Just to give an example, I
have a nephew that was recently diagnosed as HIV
positive. He hasn’t even told his whole family. at’s how
bad it is.
(Southeast Asian woman, CL, SJCB)
2. Participants’ Perspectives
Before the Interventions
Participants took part in focus groups before they
attended the intervention sessions. Topics of discussion
in the focus groups before the interventions included:
key challenges in doing HIV work in their communities,
motivation for doing the work, and potential
opportunities and strategies that could be used to
advance HIV advocacy work. Similar themes were
identied by both PLHIV and non-PLHIV CL participants.
2.1 Key Challenges in Addressing
HIV in Ethno-racial Minority and
Newcomer Communities
CHAMP participants identied a number of challenges
in addressing HIV in their communities:
zLower visibility and community interest about HIV
in ethno-racial minority communities in Canada
compared to some participants’ countries of origin
(e.g., Africa and the Caribbean).
zCommunity fear of associated stigma related to HIV
is heightened by existing systemic discrimination
such as racism and marginalization of refugees.
zConservative religious doctrines, dominant
patriarchal values, sex-negative attitudes, and
transphobia/homophobia in mainstream and
ethno-racial minority communities create an unsafe
environment for open discussions of sexuality and
HIV related issues.
zExperiences of stigma and discrimination result in
fear of disclosure and reluctance to access support.
zLack of visible PLHIV leadership and ethno-racial
minority celebrity champions further increases
community denial and complacency against HIV
work.
13
I am not really
comfortable doing advocacy work
yet, but I am volunteering at [ASO]. If I
meet somebody who needs help with accessing
HIV medication or HIV services… I’ll open up to
them and say, “Look I am in the same situation.
I sort of think about the needs of my community. I
know that, in the past month, two guys from my
country died. Aer they have arrived here, they
died and I think that sort of hit me.
(African man, PLHIV, ACT+SJCB)
Family values… I guess my upbringing…
I would say there is a need to look aer
others in society. Also religious teaching.
ere is an inspiration that you are helping
humanity… helping God’s creation. So that is
my motivation and inspiration as well.
(South Asian woman, CL, SJCB)
I worked most of my life downtown
Toronto. In the last 15 years, I have seen people
eating from garbage cans and people are dying on
the street freezing to death. at is what prompted
us to form an organization to help the homeless.
Social justice is at the bottom of the agenda. We
have to do a lot of advocacy with politicians. HIV
is the addition, the latest addition, to the agenda of
many areas in social services. It will take some time
before the faith community can go on board . . .
(South Asian man, CL, SJCB)
[Criminalization of
non-disclosure]… stu like that
does not help. e media just put the
information, the pictures, and all that stu
out there so its painted a bad image about
people who are HIV+… and that made people
scared about talking about HIV/AIDS.
(Caribbean woman, PLHIV, SJCB)
2.2 Personal Motivators for Getting
Involved in HIV Work
When asked about what motivated them to engage in
HIV work, participants shared the following:
zPersonal awareness or experiences of stigma and
discrimination related to HIV or other social injustices
(e.g. homophobia).
zInspiration from PLHIV leaders in their own
communities.
zPrevious engagement in advocacy work related to
global health, sexual health, and LGBT activism.
zAssociation and/or partnership with AIDS service
organizations, peer networks, or community
coalitions.
zPersonal values of social justice and compassion.
2.3 Personal Barriers to Getting
Involved in HIV Work
CHAMP participants also identied numerous barriers to
engaging in HIV work:
zLack of time and competing demands such as work/
school, immigration/settlement processes, and
engagement in other social justice issues.
zFear of associated stigma related to HIV (such as
homophobia, addiction, etc.).
zFear of community gossip, rejection, and loss of
support systems.
zConcerns about not having specic knowledge,
skills, and connections needed to champion HIV
related issues.
zFear related to repressive public policies like the
criminalization of HIV non-disclosure.
14
2.4 Potential Strategies and
Opportunities to Advance HIV Work
CHAMP participants suggested some potential strategies
to advance HIV work in dierent sectors:
zEngage school system and target youth with age-
specic messaging on HIV and sexual health issues.
zEngage parents to improve skills in communicating
with their children on sexual health issues.
zIntegrate HIV training in faith-based professional
curriculums.
zEstablish HIV programs within faith-based
communities and institutions.
zIncrease alliance in joint advocacy and public
education to address HIV and other social justice
issues.
zIncrease community capacity building on public
speaking and media skills on HIV issues.
e church is the ock; the shepherd
is the priest. So, if he can talk about it to the
church and word is going to fall on the ground
and people will be informed about it.
(African woman, PLHIV, ACT+SJCB)
I like to engage the media because they
have the role to play as well. And just
because they’re not doing it now, doesn’t
mean that we have to wait til they’re
ready. I think we just have to do it and
make it loud and make it obvious.
(East Asian man , CL, ACT+SJCB)
15
8 Stigma and social injustice issues in the scale include HIV stigma, sexism, homophobia, transphobia, domestic violence, and poverty.
9 Reverse coding refers to the reversed score assigned to certain statements in a questionnaire that run in a contrary direction to the rest of the
statements in the questionnaire. For example, in the stigma scale, most items when not endorsed suggest lower stigma (e.g. “People who have
AIDS are dirty.), while a few items when not endorsed suggest higher stigma (e.g. “It is safe for people who have AIDS to work with children.).
Some participants may get confused by the switch in orientation or miss this when reading quickly.
3. Participants’ Perspectives
After the Interventions
3.1 Survey Results
Participants completed questionnaires made up
of validated scales that measure HIV stigma, anti-
oppressive attitudes and intentions, psychological
exibility, and sense of empowerment.
In total, 62 participants completed all three waves
of measurement: before the interventions (Wave 1),
immediately after the interventions (Wave 2), and nine
months after the interventions (Wave 3).
Regression analysis showed that there were no
signicant dierences in all measures between the
intervention groups (i.e. SJCB only vs. ACT+SJCB) or
between participant group types (PLHIV vs. non-PLHIV
CLs). As a result, all participants were analyzed as a
group and the results are summarized in Table 1.
(a) Stigma Reduction
All participant groups showed signicant improvement
in stigma reduction after the interventions. The PLHIV
participants had signicantly decreased internalized
stigma, while Non-PLHIV CLs had decreased stigma
against HIV/AIDS.
(b) Psychological Flexibility
Measurements on hypothesized processes that might
mediate change, such as mindfulness and psychological
exibility, did not show any dierences amongst
the participants before and after the interventions.
However, there was increased consistency in all groups
between their stated values and actions.
(c) Empowerment Readiness
In terms of empowerment and readiness to champion
against HIV/AIDS stigma, there were signicant
improvements:
zIncreased tendency to speak out against stigma and
social injustice8 in social situations.
zIncreased feeling of knowledge when talking to
others about stigma and social injustices.
zIncreased condence in: talking to others about
stigma and social injustice; engaging others to ght
injustice; and mobilizing community networks to
ght stigma.
(d) Sustainable Improvements
Overall, the improvement in both stigma reduction and
empowerment readiness continued to hold between
Wave 2 (immediately after the interventions) and Wave
3 (nine-months after the interventions) when compared
to baseline. The Non-PLHIV CLs stigma scale at Wave 3
was not statistically reliable due in part to the ceiling
eect (most CLs endorsed virtually no stigma) and
the reverse coding9 of several questions. The items on
speaking out against HIV stigma in social situations fell
just below signicance (p=0.07).
16
Table 1: Summary of Data Total (n=62 - completers of all 3 waves)
Scales Wave 1
Mean (SD)
Wave 2
Mean (SD)
Wave 3†
Mean (SD)
PLHIV Internalized Stigma (IA-RSS) 15.4 (6.5) 13.3 (6.5)** 12.8 (5.6)**
CL Stigma (A-RSS + MEL items) 23.3 (8.7) 20.3 (3.6)* -
Mindfulness (Freiburg) 41.2 (6.3) 40.3 (7.4) 40.5 (5.4)
Psychological Flexibility (AAQ) 23.6 (11.3) 22.4 (10.3) 21.6 (10.1)
Values (VLQA) 67.1 (18.4) 74.5 (17.7)* 73.1 (16.8)*
Weighted Values (VLQ*VLQA) 553.6 (185.1) 651.1 (184.5)** 616.1 (180.1)*
Speaking Out in Social situations 32.4 (4.2) 33.6 (3.0)* 33.3 (4.0)
Feeling Knowledgeable 20.6 (4.0) 22.8 (4.0)** 23.3 (4.2)**
Condence to Talk 20.8 (5.6) 23.1 (3.8)** 22.7 (5.0)*
Condence to Engage others to ght injustice 20.3 (4.0) 22.4 (3.2)** 21.5 (3.4)**
Condence to Mobilize Networks 18.8 (4.5) 20.7 (3.8)** 20.2 (4.2)*
* p<0.05; ** p <0.01; † compared against Wave 1
Figure 1: Internalized Stigma among PLHIVs across 3 waves
Internalized Stigma (IA-RSS)
Wave 1 Wave 2 Wave 3
Figure 2: Weighted Action-Values consistency across 3 waves
Weighted Values (VLQ*VLQA)
Wave 1 Wave 2 Wave 3
Figure 3: Empowerment Readiness across 3 waves
Empowerment Readiness
Wave 1
Wave 2
Wave 3
Condence to Talk
Condence to Engage
Speaking Out
Feeling...
Condent to...
17
At the same time, the training helped me
to unlearn some of my prejudices. And it
actually helped me in processing all the other
things I was having issues with in dealing
with people. At the end of the session I felt
more open and more trusting. Actually, it was
not me saying I don’t know these people…
aer this session, will I see them, it put me in
a place where I can say I trust these people.
(Southeast Asian woman, CL, ACT+SJCB)
3.2 Focus Group and Individual
Interview Results
We invited CHAMP participants to take part in focus
groups nine months after the interventions. Six
participants who were most active or least active in
community champion activities were invited to take
part in individual in-depth interviews. A number of key
themes emerged from our analysis of these qualitative
data.
3.2.1 Changes in Attitude Towards HIV Stigma
CHAMP participants reported increased compassion
and understanding of intersecting oppression:
zPLHIV participants reported increased self-
acceptance and self-worth and increased readiness
to disclose and engage in HIV advocacy.
zNon-PLHIV CL participants reported increased
awareness of HIV stigma and sense of empathy and
compassion towards PLHIV and others.
zParticipants from all groups identied the
interconnection between HIV stigma and other
forms of social oppression (i.e., classism, sexism,
homophobia, and transphobia). They also expressed
increased intent towards championing and speaking
out against HIV stigma and social injustices.
Personally, in the past, I had discriminated against
people with HIV. Before I thought they got it
because of the mess in their lives but aer CHAMP
I know it is not the situation. So CHAMP gave me
the opportunity to get a lot of knowledge
(Southeast Asian woman, CL, ACT+SJCB)
With CHAMP I learned about dierent
issues like anti-racism, feminism and stu like
that. Looking around the room, none of us are
white; we are majorities. We are ethnic majorities;
we have been discriminating. I have been
discriminated for my Caribbean accent. At the
same time…we all feel it, so kudos, kudos!
(Caribbean man, CL, ACT+SJCB)
Stigma is too big up there…
you know you’re even afraid to say I am
HIV positive; but when I enter to the study, it made
me realize how important it is to take the stigma out of
your life. You can do exercise because people don’t know. You
can have friends. You can have social life but when I came here
I learned to break that wall from my life. Stigma is not in my
dictionary. It is not in my vocabulary… I have now nine months
when I have been open that I am HIV+. Look at me - I am a
trans person. In some way it is now easy for me to accept and
be open and tell everybody, friends, workers…everybody…o
including…I put it in my resume now that I am HIV positive.
(Latino trans-woman, PLHIV, ACT+SJCB )
18
3.2.2 Inspiration and Motivation to Pursue
Life Goals
CHAMP participants reported increased empowerment
and motivation to pursue expanded life goals:
zMany PLHIV participants shared that since CHAMP,
they have joined groups for networking, emotional
support, and peer disclosure.
zMany PLHIV also reported that they were proactively
pursuing new goals based on their values and what
matters to them (such as relationships, education,
etc.).
zParticipants from all groups shared that they were
motivated to take on leadership roles at work,
school, and other social settings. They also reported
collaborating more with community partners to
address broader social equity issues (e.g., access to
health care by refugees).
Aer doing the
study, I travelled to my country.
Yes…and I shared a lot about myself with
my family members. I also got engaged. But before
I got engaged, I was open to my man that I was HIV
positive. When I got to my country, I told him we have
to go to the testing centre. ey told me, “You are HIV
positive.” I knew already. And then they told him, “You are
negative.” He said to me, “I love you the way you are.” is
December I might be going back for our wedding.
(African woman, PLHIV,
ACT+SJCB)
I am in school
now…and God willing my wish is to
go for nursing. I think that is the perfect eld to
draw people who don’t know about HIV, either clients
or friends. When you are a nurse, you become a role model.
People look up to you. And most people think that if you are
nurse, you are negative. So in that eld I would be that face.
Being positive is not a scary thing. It’s life. Everybody can achieve
up to this far. I was positive before I became a nurse. I was able
to push my life where I wanted. I am still living life like anybody
else. And then on top of that, when you are a nurse, you can
easily become a shoulder to cry on for anybody, so that is
what I am looking forward to become a nurse.
(African woman, PLHIV, ACT+SJCB)
I felt I could challenge things that I
disagreed with. It is something I used to
keep inside or kind of talk to someone
close. In fact I did. As a racialized woman
in Canada, it hasn’t been easy; I have had
employers taking advantage of me. Aer
CHAMP, I felt it was okay to challenge
people in the context of homophobia. I nd
that challenging your own people is like
challenging other people because you…I
have a connection with people. It is a little
bit risky, but it’s okay. It is something that’s
what I took from the program.
(Latino woman, CL, SJCB)
19
3.2.3 Empowerment and Active Stigma
Reduction
CHAMP participants reported increased individual and
collective empowerment:
zMany PLHIV participants reported that they had
disclosed their HIV status in personal and communal
settings (such as family, friends, class, church etc.).
zAll participant groups reported taking action to:
{Challenge HIV stigma through personal networks,
work-place, and community organizations/
institutions.
{Conduct HIV education in faith based
organizations, community spaces, and online
through social media.
{Increase social networks and allies to advocate on
social issues (e.g. migrant labour rights, housing,
anti-poverty, PLHIV and LGBTQ issues).
Aer
doing the study, I
visited my country. I was afraid…I
was afraid to go there to face my people--
especially with my husband’s people. But when
I got there I was a changed person. I managed to
share a lot about myself and I helped some of my family
members who were sick and did not want to come out.
[…] I started disclosing my HIV status back home because
of the way people were talking, like - “I have never seen a
person living with HIV…somebody should look like this.
And I started saying, “Here I am.” And I was thinking,
“e CHAMP study is going to start that journey again
here [in Canada].” Because I did that to the lecturer and
the following week I was in another class and this teacher
asked something about HIV and I said, “Yes, because I am
HIV positive.” It kind of comes, and I am not disclosing
because I want attention. I am disclosing to reduce the
ignorance that is out there, or the stigma that is out
there, and I am kind of trying to observe at the
same time how people react toward me.
(African woman, PLHIV, ACT+SJCB)
From the
CHAMP study to today, I’ve
become member of the board and steering
committee of an ASO (AIDS Service Organization)
because CHAMP for me was a very brilliant experience,
so I want to contribute to the ASO. Because I joined the
CHAMP study, I become a worker for ASO. I have been
active in the ASO community in the forms of focus group and
many activities. Because of CHAMP I nished a workshop on
disclosure management. I used to have issues with disclosure
so I was working on that. Finally I backed it up with the
CHAMP study so from there I have no problem and issues
le to disclosing my HIV status--so I now am fully
involved in the ASO community.
(Latino man, PLHIV, SJCB)
I have been facing challenges as
a trans-person with regards to transphobia
for over 11 years. I had to defend myself on the
streets and I had to confront people who looked at me
dierently or used transphobic words. Now thanks to
CHAMP, I am a leader and I take on a leadership role
to educate people about stigma and transphobia.
(Latino trans-woman, PLHIV, ACT+SJCB)
e last time we met
we had the faith leaders and participants
come together and we have a whole set of activities; we
have to learn to depend on one another, put our skills on the
table, and create something for our group. For me it reinforced
the idea community building…networks with people regardless of
who they are. During that event I had the opportunity to speak with
one of the faith leaders. We discussed the need to get the message out
there. For example, [participant #3] did speaking in a church and
that takes an incredible amount of courage. I feel like I myself can
do that because of the experiences here, because of reminding
myself that word CHAMP and what that signify.
(South Asian woman, PLHIV, SJCB)
So, part of CHAMP Study actually
helps equip my presentations skills
in front of other people or in front of
a group because I had a chance to
talk about HIV/AIDS in my church
community…and like people from
my country. And some of them I
found that they are so ignorant. But
then I still try to talk…and in my
school when I have the chance to
talk about any other social issues like
HIV and AIDS discrimination.
(African man, CL, SJCB)
20
3.2.4 Community Building to Advance HIV
Championship
CHAMP participants identied community building,
expansion of supportive networks, and ongoing
capacity building as critical strategies for advancing
long term anti-stigma work:
zParticipants from all groups recognize that more
stigma reduction work needs to be done and many
challenges remain in addressing deeply entrenched
societal oppressions.
zThey identied networking and alliance building
across sectors and across cultural groups; ongoing
connections for peer support; critical dialogue; and
capacity building on media and advocacy skills as
critical strategies to facilitate long term eective HIV
championship.
CHAMP’s networking session was very
informative. It was enlightening to hear
about others’ accomplishments on stigma
reduction and it helps to foster new
networking mechanisms with others.
(Caribbean man, CL, ACT+SJCB)
I mean, I really enjoyed CHAMP
not only just the learning opportunity but
also the interaction with people. We talked to
each other and listened to each other’s stories.
at’s more important than the knowledge to
me, because you know, I have a community
of people that I can now connect to and I
feel that very much reinforces the learning
experience…and I am working with groups of
people that are real and I know that I am not
alone. ats the fun part and the good part.
(East Asian man, CL, ACT+SJCB)
For me, not so much the media,
but how to tell the story…because a lot of us
have a story to tell. Most of us have a story to
tell but how to tell it is a big problem.
(Caribbean man, PLHIV, ACT+SJCB)
For me it is just dialogue, dialogue, and
dialogue. e more you talk and the more
educated people become, the more interested
they become, the more myths that are
dispelled, the more stigma that are dropped
the more you talk. I just talk about things
that are important to me...
(Black Indigenous woman, CL, ACT+SJCB)
With me like I am trying to maximize every
speaking opportunity that I get to talk about
HIV/AIDS. When there is any community
function or event, I ask if they want me to
talk about HIV/AIDS or related issues. I am
still waiting to see if they will get back to me.
at’s is my goal, my thing, let the people
know HIV/AIDS is real, it is out there, it is
in our power and best interest to ght it and
eventually we will be able to win.
(African man, CL, SJCB)
21
Action Levels
Action Areas
Personal
Family,
Friends,
Co-workers
Community,
Organizational,
Instutition
Societal Global Total
Championing against
social injustices 20 63 105 19 2 209
Promotion of care and
support for PLHIVs 11 42 31 1 8 93
Supporting HIV
prevention educaton
and awareness
10 59 31 8 2 110
Championing against
HIV related stigma and
discrimination
21 78 88 11 4 202
Community building
and networking 18 37 102 24 6 187
Empowerment and
resilience 98 105 72 6 8 289
TO TAL 178 384 429 69 30 1090
Table 2: Champions in Action: Activity Log Summary
3.3 Results from Monthly Activity Logs
In this study, we applied a health promotion evaluation
strategy and monthly activity logs to capture the impact
of ACT and SJCB on HIV/ social justice championship.
Using the activity logs proved to be an important
evaluation tool. It enabled us to demonstrate not only
changes in participants’ attitudes but also to document
their actual behaviours and actions for social change.
Participants were asked to keep a monthly activity log to
track their HIV championship and social justice activities
over nine months after the interventions. At the end
of each month, research team members contacted the
participants to collect their activity logs. Based on our
analysis of the submitted data and team discussions,
the activities were grouped into six broad action areas
across ve levels (personal, interpersonal, community,
societal, and global/international).
Table 2 summarizes the number of activities under
each action area. Over a period of nine months after
the interventions, our 62 CHAMP participants carried
out a total of 1090 HIV and social justice champion
activities. As illustrated by participant narratives in the
next section, these champion activities demonstrated
that ACT and SJCB were eective in achieving the
intervention goals (i.e., to address internal/ enacted
HIV and other social stigmas, promote individual and
collective empowerment, and mobilize community
engagement and collaboration towards social change).
22
C
H
A
M
P
“I participated in demonstration
against IFH (Interim Federal Health)
funding cuts at the CIC (Citizenship and
Immigration Canada) oce on St. Claire.
Interacted with CHAMP people and
other community members to advocate
for restoring refugee health care.
( Caribbean man, PLHIV, ACT+SJCB)
“I went to my church and introduced a
topic about confronting the discrimination
against gay, bisexual, and lesbian people. I
specically talked to the chairperson of the
youth and asked “what is the position of the
church on gay, bisexual, and lesbian people? “
( African man, CL, SJCB)
3.3.1 Action Area #1: Championing Against
Social Injustices
zConfronted homophobia in faith and academic
institutions.
zAdvocated for social justice (such as refugee health,
LGBT issues, womens rights, migrant worker rights
etc.).
zOrganized community and educational activities on
LGBT, immigrant, and refugee issues.
3.3.2 Action Area #2: Promoting Care and
Support for PLHIV
zProvided peer support through disclosure and
sharing resilience strategies.
zPromoted access to social determinants of health
(e.g. housing, education, and employment).
zFacilitated referrals and access to health, social, and
legal support for other PLHIV.
“I helped
a friend by referring him
to HALCO (HIV/AIDS Legal
Clinic Ontario) for legal support. He
is from Dominican Republic and had
no idea about how go to about his legal
matters concerning HIV.
( African man, PLHIV, ACT+SJCB)
“I organized and facilitated a half-day forum on
anti-racism and anti-homophobia for Chinese
youth in the GTA at the Asian Heritage forum.
75 youth attended the forum. 25 of them signed
up to join future anti-homophobia activities.
(East Asian woman, CL, ACT + SJCB)
“ I am planning to establish a working
relationship with [Caribbean country]
and Toronto/GTA communities to get
in touch with faith leaders to start a
Food Bank drive that will benet people
aected by HIV who are living there. “
(Caribbean man, CL, SJCB)
“I met someone who
had just been diagnosed [HIV+]
upon her arrival and was so distressed. I
was able to open up to her about my status
though I didn’t have to…but I wanted her to
know she is not alone and us as CHAMPS, we
are coping and she can become one too.
(African woman, PLHIV, SJCB)
23
3.3.3 Action Area #3: Supporting HIV
Prevention Education
zConducted media-based HIV education in local
ethnic newspapers and online forums.
zConducted faith-based education in mosques and
churches.
zIntegrated HIV education in other sectors such as
labour, arts, and media.
“I made speech in a spiritual
gathering of high school students and disclosed
my HIV status without shame. I feel more open and
proud of myself when people accept me. It was well
received and people accepted me.
(Latino Trans-woman, PLHIV, ACT + SJCB)
“Our women’s group, we partnered with
Toronto Public Health to organize and conduct
women and wellness workshops addressing three bigger
health issues - HIV, Hep C, TB. We are also doing
workshops for healthy living since many people in
our group are live-in caregivers or former care givers.
We are teaching them to be healthy with healthy food
lifestyles and recreational activities.
(Southeast Asian woman, CL, ACT+SJCB)
“I have done HIV awareness campaign brochures
working with [ASO] and distributed them during
Ramadan. To follow-up, I have held meetings and
prayers on the topic in prisons and further discussed
with my family about issues of HIV, gay, and stigma. I
have written about this in our local papers.
(South Asian/West Indian man, CL, ACT+SJCB)
“I organized a workshop on HIV/
AIDS, anti-homophobia, and sexuality.
We had pamphlets on these topics. Many
people came to ask me questions about
condoms and HIV and others secretly
took away condoms. In the evening, we
showed the movie ‘Rag Tag’.
(Caribbean woman, CL, SJCB)
“I had a presentation during
Sunday class at church where I
talked about HIV/AIDS for about
15-20 minutes. Some participants
were ignorant about HIV but
they listened. I am now trying
to nd a way to talk to people in
my church about discrimination
against gay, bisexual and lesbian
people. I specically talked to the
chairperson of the youth…
(African man, CL , SJCB)
A social worker doing anti-HIV
stigma work on illegal sex workers
was referred to me. She was
working with a very tight budget
and I helped her to connect with
dierent people and organizations
to help her cause for social justice.
(East Asian man, CL, ACT+SJCB)
24
3.3.4 Action Area #4: Championing Against
HIV Stigma and Discrimination
zEstablished visible PLHIV leadership through
disclosure, peer support, education, and advocacy.
zAdvocated for public policy change through
petitions and peaceful demonstrations.
zCreated public forum and institutional access
to promote HIV awareness and advocacy for
inclusiveness of PLHIV.
“I attended an
HIV non-disclosure court hearing
and wore an ‘I am HIV+’ t-shirt to show
our concerns on this issue. We made a good
impression on the judges who agreed it is an
important issue for the community.
(East Asian man, PLHIV, ACT+SJCB)
“I made huge eorts to discuss
and spread the right information
regarding the unfair treatment
PLHV received and the stigma
attached to them. Many editors
held conventional attitude
towards them and I presented to
them what I’ve experienced and
my feelings towards PLHIV. One
newspaper out of four, and two
websites out of three, issued the
report about HIV/AIDS aer
successful liaising with the editors”
(East Asian woman, CL, SJCB)
… when I rst
arrived in the country, stigma and
discrimination caused me a lot of grief.
One of my sisters who lives here…I never
told her I was gay or bisexual. Aer CHAMP,
I told her my story. I now also found that she
is also bisexual. So I believe that being honest
and not being afraid for people to accept you for
what you are can also be a blessing. It is the same
thing I learned about stigma and discrimination.
I realized that I need to step up…I told my
daughter. ‘is is your dad and I am bisexual.
My wife also knows I am bisexual...
(Caribbean man, PLHIV, SJCB)
25
3.3.5 Action Area #5: Community Building
and Networking
zOrganized social events and celebrations such as
BBQs and birthday parties.
zRenewed sense of community participation through
volunteering at local events.
zFundraised eorts such as collecting donations for
food banks and local charities.
“ere are many incidences. Like we
had a crisis in the food bank where
we have rent of 30,000 dollars… so I
went through media and others that
we manage to raise that money to
pay o the rent to save the food bank.
at was a very signicant one.
(South Asian man, CL, SJCB)
“I volunteered for (ASO) and I plan to continue to
be involved. I did various social media awareness
initiatives on new scientic ndings on HIV medication
and treatment. I also helped set up a Facebook group
for the CHAMP study.
(East Asian man, CL, SJCB)
“I helped organize a
research summit for heterosexual males
at [hospital]; 33 people attended and we spoke
about HIV/AIDS and how it aects the heterosexuals
and were encouraged the support we got from community
organizations and health care institutions. I intend to write
an abstract to present the ndings at the OHTN (Ontario
HIV Treatment Network) conference and if possible CAHR
(Canadian Association of HIV Research) conference.
(Latino man, PLHIV, SJCB)
“I want to organize black
churches and mosques to bring
together Christian and Muslim
leaders and community members
to discuss HIV/AIDS issues and
learn from each other the best
practices. We also hope to have a
Joint Statement on HIV.
(Caribbean man, CL, SJCB )
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3.3.6 Action Area #6: Empowerment and
Resilience
zIncreased self-armation and acceptance of
identities (e.g. sexuality, race, HIV status).
zIncreased connectedness to broader personal and
community networks.
zIntegrated and applied CHAMP skills in dierent
areas., such as volunteering, school work, etc.
“Every time, when I actually went back
to my workplace, when I met up with my
friends, family, even other occasions at
community events where I volunteered, I
felt much more condent to speak up…to
speak my opinion because I really did feel
that I was actually part of a really bigger
group I was in. I was a lot more condent
that I felt there was this support out
there… that it wasn’t just me out there. So
I think that’s… that really sort of made me
more condent into doing a lot of things…
also confronting other dicult situations.
(East Asian man, CL, SJCB)
“For
the rst time I really
understood what are privileges
and that put me in perspective that
I was a privileged person. I realized the
importance of social justice and it became
a pathway where I want to work. Aer three
months the [exclusion circle exercise] became
signicant for me and I recognized the importance
of people working together. I understood things
that changed my vision, my everyday life vision.
I can share that with people around me in my
work, in my family, in my friends.
(Latino man, PLHIV, SJCB)
“I set a goal for myself to become a
registered nurse in ve years. I went back
to school full time to nish Grade 12.
(African woman, PLHIV, ACT+SJCB)
“I was pleased that I was
able to utilize some of the skills acquired in
the CHAMP training to educate --especially a young
generation - my nieces, nephews and their friends. ey
listened and showed interest asking good questions. It was a
gathering of teenagers and others in their early 20’s, very much
aware of the HIV impact in Black communities. I was pleased that
we connected through my story as they thanked me for sharing
my personal experience of how I overcame challenges associated
with living with HIV and nd happiness again.
(African woman, PLHIV, ACT + SJCB)
“I was the Pride Parade and Public
Gathering volunteer. is was a very
liberating and proud experience to me. It was
also my rst time to march in the parade.
(East Asian man, CL, SJCB)
27
DISCUSSIONS & REFLECTIONS
HIV stigma and discrimination are rooted in unequal
power relations and reinforced by sexism, homophobia,
racism, and other oppression. Internalized stigma is
manifested in fear, shame, and silence while enacted
stigma is reinforced through the media, law, religious
doctrine, and other social institutions. HIV stigma
and discrimination contribute to social suering and
disempowerment at both the individual and collective
levels.
We have demonstrated through CHAMP that ACT and
SJCB are eective interventions in reducing HIV stigma
and increasing empowerment. Both the qualitative and
quantitative data show that the changes in internalized
and enacted stigma are signicant and sustainable
over nine months after the interventions were
completed. Although the quantitative measures did
not demonstrate a signicant dierence between the
ACT+ SJCB groups and the SJCB only groups, qualitative
data from focus groups, interviews, and activity logs
highlight specic contributions and impact of each of
these two interventions. Participants who took part in
ACT articulated the impact of CHAMP on their ability
to address internalized stigma and conicting values.
All participants reported that SJCB training activities
contributed to their increased awareness of systemic
discrimination and motivation to engage in community
level actions.
The overall outcome of CHAMP conrms our original
research assumptions that enabling PLHIV leadership
and cross-sector engagement in HIV issues will reduce
HIV stigma and facilitate positive social changes. This is
demonstrated by:
zPLHIV participants’ increased condence and
comfort with HIV disclosure. Many took action to
educate others about HIV within their own social
networks and communities. They also increased
collaboration with other ethno-racial organizations
to work on HIV and other social justice issues.
zNon-PLHIV CL participants increased their
participation and collaboration with HIV
communities; they also proactively integrated HIV
related issues in their organizations and work places.
zIn the structured networking sessions, PLHIV
participants openly disclosed their status and
worked with non-PLHIV participants to develop
collaborative participant-driven HIV stigma
reduction initiatives.
zThe research process itself has contributed to
building a community with members who share a
sense of camaraderie and identify themselves as HIV
champions. It is expected that the impact of their
work will increase as they contribute to changes
in their own personal networks, organizations,
workplaces, and broader communities.
Furthermore, our focus group data and eld notes from
the training sessions show that CHAMP was eective in
facilitating individual and collective transformation as
follows:
Facilitation of stigma reduction: CHAMP used
experiential exercises (such as the Sculpture of Stigma
and Labelling in ACT) to support participants in getting
unstuck from their sense of shame and their perception
of having “permanent” negative identities associated
with their experience of marginalization. These exercises
supported participants to connect to an “expanded”
sense of self (e.g., I am much more than HIV, or I am
much more than my accent) and to loosen themselves
from the hold of stigmatizing labels and shame. These
insights promoted self- acceptance which in turn
fostered acceptance and compassion for others.
CHAMP Eectiveness in Reducing HIV Stigma
28
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Facilitation of mutual empathy, acceptance, and
compassion: CHAMP provided a safe space for
dialogue and collaborative learning that honoured the
participants’ lived experiences and enhanced critical
reection on their social positioning as ethno-racial
minority people from dierent walks of life. CHAMP
used interactive exercises (such as The Exclusionary
Circle10 and Understanding Power and Social Justice in
SJCB) that enabled participants to make sense of how
racism, homophobia, sexism, transphobia, citizenship
status, poverty, and other marginalizations intersect to
produce suering and health disparities. Through the
sharing of lived experiences, deep listening, reection
and dialogue, participants gained insight about
the situational context of their identities and social
positioning. That is, they shared similar experiences
of being marginalized and at the same time they
also occupied dierent positions of privileges and
unknowingly engaged in oppression. These insights
promoted mutual understanding, solidarity, and
commitment towards collaborative eorts to address
stigma and social injustices as demonstrated in the
participant driven initiatives.
Facilitation of new vision and hope for change:
The collaborative learning in CHAMP enabled the
participants to become more aware of the existence
of a broad supportive network of communities that
shared common struggles and overlapping aspirations.
The interactive exercises also enabled participants
to recognize possibilities for change and options for
concrete action. CHAMP demonstrated its eectiveness
in facilitating empowerment, increased connection,
collective hope, and inspiration for collaborative action.
Promotion of individual and community resilience:
Through deep listening, critical dialogue and reection,
CHAMP participants supported each other to identify
their strengths and skills. Although they faced ongoing
complex challenges, they were able to recognize the
eectiveness and the possibilities of applying resilience
strategies they had used successfully to overcome
adversities in the past. This recognition enabled
participants to look beyond adversity to identify
opportunities for growth and empowerment. For both
the CL and PLHIV participants, gaining more awareness
and celebrating the successes and resilience amongst
peer groups had a powerful arming impact.
Innovative Research Designs & Impact
The CHAMP study included many innovations in its
intervention design that directly contributed to its
positive impact. These include:
Meaningful and Equitable Engagement of
PLHIV
First and foremost, our commitment to advancing our
study’s objectives in promoting equity, social justice,
and collective empowerment was reected in the ways
we engaged the communities most directly aected
(the PLHIV from the target ethno-racial communities).
PLHIV identied the needs of the study, chose the
interventions to be evaluated, and took on central
roles as research team members, sta, participants,
and knowledge transfer agents. Specic training and
resource investments were built into the project to
ensure meaningful and equitable engagement of PLHIV.
Capacity building and team building activities
were integrated into all phases of the study to
promote mutual learning amongst academic and
community team members to ensure equitable
and meaningful project participation. Training
included skills in community based research
principles and methodologies, intervention design,
community engagement strategies, research ethics,
logistic coordination, data collection, data analysis,
recommendation development, and knowledge transfer
exchange strategies. As a result, PLHIV sta and research
team members took on shared leadership roles not
only as peer assistants or recruiters /associates, but
10 Wong, J. P. & Li, A. T. (2015) The Exclusionary Circle Game: A tool to promote critical dialogue about HIV stigma and
social justice. Progress in Community Health Partnerships: Research, Education, and Action, 9(3), 431-438.
29
also as integral members of the team throughout all
research project stages. Their visible and meaningful
participation had profound inspiring impacts on both
fellow team members and research participants in
advancing HIV stigma reduction championships.
Experiential Focus of Intervention Activities
Most of the intervention activities employed an
experiential learning approach that included structured
activities to guide participants to reect on their own
lived experiences and explore insights and responses
to real-life scenarios. It also included interactive
dialogue for participants to share their experiences.
This approach facilitated emotional engagement and
connection to personal experiences and promoted
personal investment in participation and bonding
amongst participants. Lastly it enabled self-reection
and recognition of strengths and resilience.
Cross-cultural and Cross-sector Engagement
of Participants
Our study engaged leaders and activists from four
sectors (PLHIV, faith, media, and social justice) and three
culturally diverse communities (African/Caribbean,
Asian and Latino) in dialogue and interactive learning
during the interventions.This design had multiple
benets. It provided opportunities for participants
to gain insight from more diverse perspectives; it
also facilitated recognition of systemic barriers and
universal struggles to counter the tendency to lay blame
on a specic culture, faith, or sector of society. This
engagement process also broke down the silos within
dierent sectors of communities and expanded the safe
and non-stigmatizing spaces within them. In addition, it
provided opportunities to connect and mobilize across
sectors and facilitate collaborative activities.
Activity Log to Track Action Outcome and
Impact
The use of a monthly activity log as a data collection
tool had multiple benets. First, it enabled us to
track actual behavioral changes rather than simply
documenting and evaluating attitudinal and
perspective changes amongst the participants. In
addition, the tracking process enabled dialogue and
reection from participants to reinforce their awareness
of self-strength and resilience.
Structured Networking to Promote Sustained
Engagement
The study organized two structured networking
sessions at three-months and nine-months after
interventions. The sessions invited all participants to
network with each other, to share interim experiences
about their HIV stigma reduction initiatives, and to
explore collaborative projects of mutual interest. These
sessions were strategically designed to achieve multiple
objectives. By having both PLHIV and non-PLHIV CLs
work together, these sessions had a de-stigmatizing
impact. It provided a relative safe space for PLHIV
champions to take on visible championship roles within
broader communities and opportunities for non-PLHIV
CLs to gain more personal connections to PLHIV. In
addition, these sessions provided opportunities for
collaborative development of participant-driven
knowledge translation and exchange projects and
contributed to further long term community building.
Structured networking was a critical strategy for
sustaining and maximizing the impact of CHAMP.
30
RECOMMENDATIONS
Implications for Practice
zCommunity HIV stigma reduction programs must:
{Be underpinned by principles of empowerment
and capacity building.
{Address stigma at the intrapersonal, interpersonal,
and community levels
{Honour lived experiences and apply emotive and
cognitive learning that promote connections,
mutual empathy, and compassion.
{Tap into cross-cultural and cross-sector
collaboration to create de-stigmatizing and
inclusive social spaces and to advance solidarity
towards social justice championship.
zStigma reduction strategies within health and
social organizations must:
{Go beyond GIPA (greater involvement of people
living with HIV/AIDS) to incorporate MEEPA
(meaningful and equitable engagement of people
living with HIV/AIDS) into policy and operation.
{Build skills among service providers to promote
awareness of resilience of self and clients.
{Provide sta with stigma reduction training to
address internalized and enacted stigma.
zFront line sta must:
{Engage in regular self-reection to identify
internalized stigma against self and enacted
stigma against others in reference to the multiple
dimensions of socially constructed identities and
attributions.
{Cultivate acceptance and compassion for self and
for others to become aware of how they are all
interconnected. This lessens the perception of “us”
vs “them.
{Learn how to promote their clients’ resilience
to enacted stigma, capacity for increased
psychological exibility, and readiness to
advocate for themselves and others.
Implications for Research
zUse “transdisciplinary“ mixed methods to study
stigma and capture contextual eects and document
outcomes.
zDraw on research evidence specic to ACT and SJCB
to develop an integrated model of stigma reduction
and resilience promotion (ACT2SJCB).
zEstablish networks to pilot and evaluate the use
of ACT2SJCB in community real life settings across
sectors.
zConduct follow-up research to capture the long-term
impact of CHAMP’s participant-driven knowledge
transfer strategies.
zEvaluate the adaptability and assess the structural
requirements needed to replicate CHAMP
interventions in community real life settings.
Implications for Policies
zAll health and social service organizations must
integrate HIV stigma reduction policies to guide
organizational operation and service provisions.
zInterfaith councils and individual faith based
organizations must adopt anti-discrimination and
anti-HIV stigma policies.
zHIV stigma reduction must be integrated into the
public education system.
zGovernment programming and research funding
bodies must recognize HIV stigma reduction
interventions as a priority for funding to support its
research and practices.
zStigma reduction strategies need to be supported
by systemic policy change to eliminate social
injustice and inequities that reinforce HIV stigma and
discrimination (e.g., criminalization of sexual non-
disclosure of HIV must be eliminated).
Design: Aries Cheung at TransMedia9
465 Dundas Street East
Toronto, ON M5A 2B2
416-364-2261 ext 2277
Website: www.hivimmigration.ca
E-mails: coordinator@hivimmigration.ca
Facebook.com/HIVImmigration
@HIVImmigration
Graphic Design: Aries Cheung at TransMedia9
Community
Champions
HIV/AIDS
Advocates
Mobilization
Project
Reducing HIV Stigma
and Advancing
Equity Through
Committed Action
Research Report
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... Fung and Wong engaged in an innovative community-based intervention study, Community Champions HIV/AIDS Advocates Mobilization Project (CHAMP) [24,25,26] that evaluated the use of two interventions, Acceptance and Commitment Training (ACT) and Social Justice Capacity Building Training (SJCB), to decrease HIV-related stigma and train HIV champions in Asian, Black, and Latino communities in Toronto. The study was unique in engaging community leaders living with and without HIV/AIDS. ...
... These include people living with and/or affected by stigma, and community leaders who have historically played a vital role in the settlement and integration processes within immigrant communities [36,37]. Involving both groups is known to build synergy of individual and collective empowerment to address stigma [26]; this study will reduce mental illness stigma and build capacity among Asian men and mobilize them to become Community Mental health Ambassadors (CMAs) as effective advocates to further address stigma in the community. ...
... Similar to CHAMP [24,25,26], this study will use an experimental design with repeated measures and mixed methods for data collection. Eligible consenting participants will be assigned to the ACT, CEE, MCI or control group using a randomization matrix. ...
Article
Background: The available evidence on interventions addressing the stigma of mental illness is limited because of small samples, lack of diversity in study samples, and exclusion of people living with mental illness. To date, no published studies have evaluated anti-stigma interventions for Asian men in Canada. Aim This paper describes the protocol of a study to evaluate psychological and collective empowerment interventions (ACT, CEE, and ACT+CEE) in addressing self-stigma and social stigma in Asian communities in three urban settings in Canada: Toronto, Calgary and Vancouver. The study targets Asian men living with or affected by mental illness, and community leaders interested in stigma reduction and advocacy. Methods: Guided by a population health promotion framework and an ecological approach to health, the study will use a repeated measure design with mixed methods for data collection. In total, 2160 participants will be enrolled to detect moderate-to-large effect sizes, while accounting for possible attrition. Participants will be randomly assigned to one of three interventions or a control group, using a randomization matrix. Established measures will be used to collect outcome data at pretest, post-test, and 3 and 6 months follow-up, along with focus group discussions and monthly activity logs. Mixed linear models will compare participants' stigma, psychological flexibility, valued life domains, mindfulness, stigma, and empowerment readiness within and between groups. Discussion: The project will generate new knowledge on the applicability and effectiveness of evidence-based psychological and collective empowerment interventions (ACT, CEE, and ACT+CEE) in addressing stigma of mental illness and mobilizing community leadership.
... The ACE model transforms two well-established mental health promotion models into one comprehensive model. It is an integration of (1) Acceptance and Commitment Therapy (ACT) (40) and (2) Group Empowerment Psychoeducation (GEP) (41)(42)(43). ACT is a mindfulness-based cognitive behavioral intervention that promotes psychological flexibility and supports psychological empowerment. It consists of six processes: "defusion (observing thoughts as thoughts), acceptance (opening up to experiencing thoughts and feelings), contact with the present moment (attending to the present mindfully), self-as-context (being in touch with the 'observer self' and increasing perspective-taking skills), values (being clear about what matters), and committed action (developing consistent patterns of behaviors based on one's chosen values)". ...
... While the effectiveness of the ACE model has been documented for stigma reduction (49,50) and collective action (36,37), the nuanced processes and outcomes of individual and collective empowerment in mental health promotion have not yet been reported in detail. In this paper, in addition to the ACE model, we draw on the empowerment continuum model, conceptualized by Jackson and colleagues (40) and adapted by other critical health promotion researchers (41,42). The empowerment continuum model encompasses individual awareness and action orientation, social connections and mutual support, getting organized to achieve collective goals, participation and shared leadership, and collective action (51)(52)(53). ...
Article
Full-text available
Background Evidence shows that there is a high prevalence of mental health challenges including depression and anxiety, among Chinese university students. Providing mental health care providers with professional training is crucial to implementing effective mental health promotion initiatives in university settings. Globally, the focus of the mental health system is shifting to recovery and the importance of empowerment is increasingly being emphasized. There is a call to integrate empowerment education into professional training programs for health service providers with the goal of mobilizing them to become mental health champions capable of advancing mental health care. Method The ACE-LYNX (Acceptance and Commitment to Empowerment–Linking Youth and Xin i.e., “heart(s)” in Chinese) intervention took place at six universities in Jinan, Shandong Province, China. It aimed to promote mental health literacy and build capacity among mental health service providers (MHSPs) to enable them to become mental health champions at their universities and beyond. A total of 139 university MHSPs participated. We collected pre-, immediate post- and three-month-post-surveys. In addition, we recruited forty-five participants to take part in three-month- post-intervention focus group interviews to explore their experiences taking part in ACE-LYNX and applying the knowledge, skills, and insights they gained from the intervention. Result This paper reports on the effects of empowerment education, which is a key component of ACE-LYNX, on the MHSPs. Four themes were identified: 1) conscious awareness and behavioral change through psychological empowerment users; 2) professional insights and motivation for organizational empowerment; 3) non-self in the continuum of collective empowerment; and 4) interdisciplinary challenges and divergences in empowerment action. Discussion We found that it is critical to integrate empowerment education into professional training. The process of MHSPs developing their empowerment practice is characterized by their moving from individual to collective empowerment along a continuum, with organizational and collective empowerment taking place in a longer time frame. Experiential learning, empathy education, and critical reflection accelerated the continuous iterative transformative process of empowerment practices. To advance the integration of empowerment into mental health care, the engagement of organizational decision-makers and policy makers in empowerment training is critical to ensure alignment of empowerment values and competence at all levels of service provision.
... ACE-LYNX is an integrated model of intervention based on two evidence-based approaches: Acceptance and Commitment Therapy (ACT) and Group Empowerment Psychoeducation (GEP) (Figure 1). The ACT model of psychological flexibility in the center of this diagram is adapted from Hayes et al [16] and the GEP model is based on the CHAMP intervention research project previously conducted by authors Li, Fung, and Wong [17][18][19]. ...
Article
Background Rapid urbanization, academic pressures, and developmental life transition stressors contribute to mental health stress for postsecondary students in China. Effective prevention, early identification, and timely intervention are challenged by stigma, a lack of mental health literacy, and inadequate mental health resources. Objective Our implementation science (IS) research project is aimed at evaluating the use of an evidence-informed mental health promotion intervention named Acceptance and Commitment to Empowerment – Linking Youth and ‘Xin’ (hearts) (ACE-LYNX) to promote university student mental health in Jinan, China. Methods We will engage and collaborate with Shandong Mental Health Center, the provincial mental health center, and six local universities in different regions of Jinan. The ACE-LYNX intervention aims to reduce social stigma against mental illness, enhance mental health literacy, and improve access to quality mental health care by increasing interdisciplinary collaboration and forming a mental health network. It is based on two evidence-based approaches, Acceptance and Commitment Therapy (ACT) and Group Empowerment Psychoeducation (GEP), and it will be delivered through online learning and in-person group training. The project will train 90 interdisciplinary professionals using the model. They will in turn train 15 professionals and 20 students at each university. The project will adopt the Reach, Efficacy, Adoption, Implementation, and Maintenance (RE-AIM) framework, which provides a structure to examine the process and outcomes of implementation using mixed methods comprising quantitative and qualitative approaches along five dimensions: reach, efficacy, adoption, implementation, and maintenance. Results Over the course of the project, 720 champions will be directly trained. They will contribute to developing a formal and informal mental health network, strengthened by student-led mental health initiatives and professional-led initiatives to promote collaborative care and facilitated care pathways. We anticipate that our project will reach out to 11,000 to 18,000 students. Conclusions This IS protocol will outline our unique intervention model and key steps to contextualize, implement, and evaluate community-based mental health intervention. International Registered Report Identifier (IRRID) PRR1-10.2196/25592
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