RISE: Reducing Cancer and HIV Stigma through Empowerment - Individuals living with cancer and HIV face unique challenges due to the confluence of dual stigma at individual, provider, community, and/or structural levels. Addressing stigma at multiple levels is critical to improving their cancer outcomes. We propose to use a randomized controlled trial to test the effects of a multilevel, culturally adapted storytelling intervention to address stigma at both patient and provider levels. The proposed project will recruit patients (i.e., Zambian women living with cancer and HIV, WLC+H) and healthcare workers at the Cancer Diseases Hospital (CDH). In the patient-level intervention, patients (N=240) will be randomly assigned to one of four conditions in a 2 (storytelling videos vs neutral videos) by 2 (storytelling disclosure vs neutral disclosure) factorial design. The storytelling videos are inspirational videos featuring actresses portraying Zambian WLC+H and sharing their stories and the storytelling disclosure involves privately speaking or writing about their experiences as WLC+H. Participants in all four conditions will attend four weekly 20-minute sessions, involving video watching and disclosure. Patient outcomes will be assessed at baseline, immediately after the intervention, and at 1-, 3-, 6- and 12-month follow-ups. We hypothesize that the intervention groups will experience improved quality of life and reduced depressive and anxiety symptoms through reduced internalized stigma and improved coping self-efficacy. In the provider-level intervention, we will explore the impacts of the intervention on workers and patients. Healthcare workers (N=100) will be randomly assigned to either an intervention group (N=50) watching storytelling videos or a waitlist control group (N=50) watching neutral videos. Worker outcomes will be self-reported at pre- and post-intervention. An anonymous patient survey will be administered to WLC+H to compare outcomes between those treated before (control cohort, N=50) and after (intervention cohort, N=50) the intervention's implementation. We hypothesize that the intervention will reduce social and enacted stigma and increase compassion among healthcare workers. It will also reduce perceived stigma and increase care satisfaction among patients. Should the interventions prove effective, an immediate outcome will be evidence-based, culturally responsive, and widely accessible interventions that support individuals experiencing dual stigmas of HIV and cancer beyond Zambia and across the globe, ultimately improving healthcare for all populations.
