ABSTRACT
HIV-related stigma has been recognized as a significant public health issue, yet gaps remain in development and evaluation of mass media interventions to reduce stigma. The Malawi 'Radio Diaries' (RD) program features people with HIV telling stories about their everyday lives. This study evaluates the program's effects on stigma and the additional effects of group discussion. Thirty villages with 10 participants each were randomized to listen to RD only, to the program followed by group discussion or to a control program. Post-intervention surveys assessed four stigma outcomes: fear of casual contact, shame, blame and judgment and willingness to disclose HIV status. Regression analyses indicated that fear of casual contact was reduced by the intervention. Shame was reduced by the radio program, but only for those reporting prior exposure to the radio program and for those who did not have a close friend or relative with HIV. Shame was not reduced when the radio program was followed by discussion. The intervention reduced blame for men and not women and for younger participants but not older participants. Including people with HIV/AIDS in mass media interventions has potential to reduce stigma.
Subject(s)
HIV Infections/psychology , Prejudice , Radio , Adolescent , Female , Humans , Malawi , Male , Young AdultABSTRACT
BACKGROUND: Arthroscopic partial meniscectomy (APM) is the most frequently performed orthopedic procedure. Functional outcomes of APM are variable, particularly among patients with underlying knee osteoarthritis. While most patients undergoing APM have knee magnetic resonance imaging (MRI) performed preoperatively, the prognostic value of knee MRI in predicting the functional outcomes of APM has not been evaluated. METHODS: We studied patients who had APM performed by one of five participating surgeons at one institution in 2002. The preoperative MRI scans of these patients were assessed using a standardized rating system by an independent observer who was not involved in the care of the patients and who was blinded to patient outcomes. Patients completed a questionnaire in the summer of 2003, 6-18 months postoperatively. The questionnaire included the Knee Injury and Osteoarthritis Outcome Score (KOOS) and items on satisfaction with the results of surgery. We used bivariate and multivariate techniques to evaluate the associations between MRI findings, other preoperative findings, and the functional status and pain scales of the KOOS. RESULTS: Eighty-three patients were included in the analyses. The outcome of surgery was variable with average KOOS functional score of 77 and range of 15-100. One-quarter of patients were somewhat or very dissatisfied with the results of surgery and 17% were using a cane at the time of follow-up. In bivariate analyses, preoperative predictors of KOOS function score at follow-up included preoperative functional status and several MRI findings including the extent of cartilage damage, bone marrow edema in the medial compartment, and length of the tear. Multivariate analyses showed that after adjusting for preoperative functional status, the extent of cartilage signal abnormality in the medial compartment on MRI remained an independent predictor of functional status, 6-18 months following surgery. Specifically, preoperative functional status explained 21% of the variability in follow-up KOOS functional status score and the extent of medial tibial cartilage damage on MRI explained an additional 16%. Analyses of knee pain 1 year following APM yielded similar findings, with preoperative functional status accounting for 17% of the variability in pain scores and medial tibial cartilage damage accounting for an additional 13%. CONCLUSIONS: Preoperative MRI findings of cartilage damage have independent prognostic value in predicting the functional outcome of APM. This study was limited by a cross-sectional design with retrospective recall of preoperative functional status. Thus, the findings need to be confirmed in prospective investigations.