Community-Based Participatory Approaches in Implementing HIV Stigma Reduction Interventions in Healthcare Settings: A Qualitative Study from Indonesia

BackgroundThis study investigated the effectiveness of a community-based participatory approach (CBPA) in implementing the "Intervensi Penghapusan Stigma dan Diskriminasi" (IPSD) intervention to reduce HIV-related stigma among healthcare workers in Indonesian primary healthcare settings. The IPSD training reached 3,162 participants across 42 primary health centres and 56 referral hospitals. The intervention engages people with HIV (PWH) and key populations (KP) as co-developers and co-implementers. Despite recognised challenges in addressing HIV-related stigma in healthcare settings, evidence on CBPA effectiveness in Indonesia remains limited. MethodsTo assess the effectiveness of CBPA in executing the IPSD intervention, 13 semi-structured, in-depth interviews and 7 focus group discussions were conducted with 40 participants, including policymakers, healthcare professionals, and community expert trainers (CETs). Thematic analysis was employed, with interview questions grounded in the Consolidated Framework for Implementation Research (CFIR) and Proctors implementation outcomes framework. Data analysis was facilitated using NVivo 14, with codes systematically categorised to identify concepts aligned with CFIR constructs. ResultsFindings reveal that CBPA fostered a more inclusive healthcare environment, demonstrated by improved provider attitudes toward people with HIV and reduced discrimination. CBPA enabled collaboration between healthcare providers, PWH, and KPs through CETs as external change agents. This study shows CBPAs potential in reducing HIV-related stigma and calls for broader adoption to achieve equitable healthcare, particularly in settings with HIV stigma. ConclusionFindings underscore the transformative potential of community participation stigma reduction interventions in public healthcare settings. By promoting structured contact and shared learning between stigmatised and non-stigmatised groups, the CBPA strengthened provider attitudes, enhanced implementation quality, and advanced equity within Indonesias healthcare system.