Mediators of the effects of an HIV prevention advocacy training intervention on prevention advocacy among persons living with HIV in Uganda.

In 30 seconds

This secondary analysis of a randomized controlled trial examined how peer advocacy training affected HIV prevention advocacy among 210 people living with HIV in Uganda. Participants reported advocacy to social network members at baseline and 6, 12, and 18 months. Compared with controls, those receiving training targeted more network members with advocacy across five behaviors: HIV testing, condom use, PrEP use, HIV care, and ART use. Mediation analyses found that reduced internalized stigma and increased HIV knowledge helped explain these effects, whereas disclosure and advocacy self-efficacy did not.

Key findings

• The intervention group targeted more social network members than controls with advocacy across all five HIV protective behaviors during follow-up.
• Reduced internalized stigma and increased HIV knowledge each fully mediated the intervention effect on HIV care advocacy.
• Reduced stigma partially mediated advocacy effects for all four other behaviors; increased knowledge partially mediated effects for HIV testing, condom use, and PrEP use.
• HIV disclosure and advocacy self-efficacy showed no mediating effect.

Why it matters

The findings suggest that advocacy training may work partly by addressing internalized stigma and strengthening HIV knowledge, rather than by changing disclosure or advocacy confidence. These potential pathways matter because advocacy by people living with HIV can extend prevention messages through their social networks. The results also distinguish which proposed mediators were associated with advocacy for different protective behaviors.

What to keep in mind

This was a secondary mediation analysis, and each mediator was assessed at month 6; the findings do not establish that changes in stigma or knowledge caused the advocacy effects.