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Randomized Controlled Trial
. 2023 Oct;27(10):3183-3196.
doi: 10.1007/s10461-023-04039-7. Epub 2023 May 17.

Can Self-affirmation Encourage HIV-Prevention? Evidence from Female Sex Workers in Senegal

Sara Haire  1 , Aurélia Lépine  2 , Daniel A Effron  3 , Carole Treibich  4
Affiliations
Randomized Controlled Trial

Can Self-affirmation Encourage HIV-Prevention? Evidence from Female Sex Workers in Senegal

Sara Haire et al. AIDS Behav. 2023 Oct.

Abstract

We test an intervention aiming to increase condom usage and HIV testing in a stigmatized population at high risk of contracting HIV: female sex workers (FSWs) in Senegal. Some sex work is legal in Senegal, and condoms and HIV tests are freely available to registered FSWs-but FSWs may be reluctant to get tested and use condoms, in part because doing so would entail acknowledging their risk of contracting HIV and potentially expose them to stigma. Drawing on self-affirmation theory, we hypothesized that reflecting on a source of personal pride would help participants acknowledge their risk of HIV, intend to use condoms more frequently, and take an HIV test. Prior research suggests that similar self-affirmation interventions can help people acknowledge their health risks and improve their health behavior, especially when paired with information about effectively managing their health (i.e., self-efficacy information). However, such interventions have primarily been tested in the United States and United Kingdom, and their generalizability outside of these contexts is unclear. Our high-powered experiment randomly assigned participants (N = 592 FSWs; N = 563 in the final analysis) to a self-affirmation condition or a control condition and measured their risk perceptions, whether they took condoms offered to them, and whether (after randomly receiving or not receiving self-efficacy information) they took an HIV test. We found no support for any of our hypotheses. We discuss several explanations for these null results based on the stigma attached to sex work and HIV, cross-cultural generalizability of self-affirmation interventions, and robustness of previous findings.

Keywords: Female sex work; HIV; Health; Self-affirmation; Self-efficacy; Stigma.

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Conflict of interest statement

There is no conflict of interest.

Figures

Fig. 1
Fig. 1
Number of observations per treatment groups. a Total sample. b Excluding inactive and HIV-positive FSWs
Fig. 2
Fig. 2
Characteristics of the self-affirmation experiment. a Time spent speaking (by group). b Experiences that made participants feel proud (by group)
See this image and copyright information in PMC

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