Tuesday, April 6, 2021

Will Story, assistant professor in the University of Iowa (UI) College of Public Health, and Nema Aluku, research associate at Tangaza University College in Nairobi, Kenya, were recently awarded a National Institutes of Health (NIH) grant to study HIV stigma among adolescents in western Kenya. The study represents a promising international collaboration with significant public health insights. Learn more about this important research project through the Q&A below with Dr. Story and Dr. Aluku. 

International Programs: You were recently awarded a National Institute of Health (NIH) grant to explore HIV stigma among adolescents in western Kenya. Can you tell us more about this research?

Image of Will Story

Will Story

Dr. Story: Adolescents, especially girls, are vulnerable to HIV in Kenya, where stigma and discrimination present an important challenge to HIV prevention. Understanding the complex relationship between social relationships, religious beliefs, and gender norms is critical to developing culturally appropriate interventions to reduce stigma among adolescents, but rarely studied in this population. This project will identify potential pathways to reduce HIV-related stigma and increase HIV-preventive behaviors among adolescents in western Kenya, while building the research capacity of two Kenyan institutions—Tangaza University College in Nairobi and Gynocare Women’s and Fistula Hospital in Eldoret.

International Programs: The research project involves a partnership with the University of Iowa, Tangaza University College in Nairobi, Kenya, and Gynocare Women’s and Fistula Hospital in Eldoret, Kenya. Who are the principal researchers and how did this partnership form?

Image of Nema Aluku

Nema Aluku

Dr. Aluku: The principal investigators are Dr. Story (University of Iowa) and myself (Dr. Aluku, Tangaza University College). Dr. Story and I have worked collaboratively over the last 15 years on various projects in east and southern Africa. The partnership between the University of Iowa and Tangaza University College dates back to December 2017 when Dr. Story invited me to give a virtual lecture in a course titled Global Maternal, Newborn, and Child Health (CBH:6405). I was later invited to visit the UI College of Public health as a Global Visiting Scholar in October 2018, where I gave a lecture at the CPH spotlight series called Cultural and Religious Influences on the Risk of HIV Infection among Women of Reproductive Age. I was encouraged by the student and faculty turnout during the presentation and was informed that a total of 72 participants attended the session—making it the second largest seminar by a visiting scholar in the UI College of Public Health. During my visit, I had the opportunity to meet with several individuals in the UI College of Public Health, including: Edith Parker, dean; Cori Peek-Asa, professor and associate dean for research; Dr. Rima Afifi, who was then interim department head of Community and Behavioral Health; and Sophie Switzer, global public health coordinator. During my conversations with Sophie Switzer and Dr. Story, we reviewed a potential partnership between Tangaza University College and the University of Iowa. The idea was later shared with contacts at Tangaza University College—DVC Academic Professor Sahaya Selvam and Dr. Beatrice Churu, dean of the School of Arts and Social Sciences—who reviewed the Memorandum of Understanding (MoU) and were in agreement with the possible partnership.  The MoU was later signed and endorsed in November 2018 by the then Tangaza University College Principal Dr. Tom Kearney. The MoU stipulates some general forms of cooperation between the two institutions including joint educational, training and/or research activities, exchange of invitations to scholars, and exchange of faculty, research personnel, and graduate and undergraduate students for study and research.  Gynocare Women’s and Fistula Hospital was brought on board through an ongoing partnership between a not-for-profit organization Africa Community Leadership and Development (ACLAD). This research project is a culmination of many years of collaborative work that has brought together a diverse team of researchers.

International Programs: How long will the research project last and what types of research methods will be utilized?

Dr. Story: This is a two-year mixed-methods research project that started in August 2020. We started by developing contextualized measures of social capital (i.e., the resources, norms, and values that accrue to individuals and groups through their social relationships), religiosity, gender norms, and HIV-related stigma in western Kenya. We used cognitive interviewing techniques to contextualize and validate four existing scales and we are getting ready to assess the psychometric properties of these contextualized measures through a pilot survey administered to a sample of 270 adolescents. After making further revisions, we will administer the survey to 765 randomly selected unmarried girls and boys (ages 15-19) from three counties in western Kenya. We will use this data to examine the relationships between social capital, religiosity, gender norms, social stigma, and HIV-preventive behaviors (i.e., condom use and HIV testing). After the survey, we will further explore the relationships between social capital, religiosity, gender norms, and HIV-related stigma by conducting 36 in-depth interviews with adolescents (ages 15-19), parents, religious leaders, teachers, and healthcare providers.

International Programs: How do you plan to build on this research once the project is complete?

Dr. Story: At the completion of this project, we expect to be able to identify subpopulations of youth at risk for HIV, types of social capital associated with stigma, how stigma affects HIV risk behaviors, and how the relationship between social capital and stigma varies by religiosity and attitudes related to gender norms. We plan to use our findings to develop a new three-year NIH application for a cluster-randomized community trial to evaluate an intervention to strengthen social capital, harness positive attributes of religiosity, reduce harmful gender norms, and diminish stigma among youth.

International Programs: Do you anticipate that your research findings will be helpful in locations outside of western Kenya?

Dr. Aluku: We do anticipate that the research will advance HIV stigma related interventions through the increased research capacity of Tangaza University College and Gynocare Women’s and Fistula Hospital. We envisage that after this two-year project, these institutions can address HIV stigma and promote young people’s health throughout Kenya.