A Qualitative Study of the Adaptation of a Facility-Level Training Using “What Matters Most” to Reduce Intersectional Stigma Toward Pregnant Women Living With HIV in Botswana

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ABSTRACT: In response to the need for robust interventions to reduce HIV-related stigma, we used the "What Matters Most" (WMM) conceptual framework to adapt the participatory training component of the Total Facility Approach (TFA), a health facility-based stigma reduction intervention, to reduce the intersectional stigma toward pregnant women living with HIV in Botswana. We report on the adaptation and pilot testing of this intervention, which included interweaving the specific points of stigma and discrimination for pregnant and postpartum women living with HIV into the TFA training manual. Focus group discussion results suggested the WMM-adapted TFA training is an acceptable, appropriate, and feasible model for use with nurses and other health care professionals caring for mothers living with HIV in the prenatal/postpartum period with some nuances concerning broader relevance to patients served (nonpregnant women and men). Future studies can explore the use of WMM and the full TFA intervention together to reduce intersectional stigma that structurally limits individuals' ability to seek and receive effective care and to achieve what they most value.

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