{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T16:23:17Z","timestamp":1793463797188,"version":"4.5.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T00:00:00Z","timestamp":1698969600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K01MH119973"],"award-info":[{"award-number":["K01MH119973"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Strong policy guidance has recently emerged identifying focal points at multiple levels and across sectors to end the persistent HIV pandemic and related inequities. Reducing the policy-implementation gap, as with the evidence-policy gap, requires strategic alignment between interventional research and policy realms. Global- and national-level HIV policy indicate a need for community-led efforts to reduce HIV stigma, and increase uptake of HIV prevention tools.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study assesses a process-driven approach to facilitating community-led efforts to reduce HIV stigma, and build a generative context for community-led HIV prevention. The study intervention combines an adapted group-based microfinance process, a novel psychological curriculum, and leadership development at a scale now involving over 10,000 rural Kenyans across 39 villages.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Consistent with interventional goals, and current relevant psychosocial theories, we find collective emotion, and HIV stigma (blame and discrimination) significantly improve with more time participating in the in the program and novel curriculum. Further, HIV stigma predicts subsequent reporting of ever being tested for HIV, and the intervention led to the development of \u201cHIV prevention resource committees\u201d \u2013 groups of participants committed to undergo training to reduce HIV stigma and prevent HIV within their communities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Implications for further research to reduce the HIV policy-implementation gap are discussed, directly within this interventional context and more generally.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2023.1240200","type":"journal-article","created":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T10:26:40Z","timestamp":1699007200000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["A social innovation to empower community-led monitoring and mobilization for HIV prevention in rural Kenya: experimenting to reduce the HIV prevention policy-implementation gap"],"prefix":"10.3389","volume":"11","author":[{"given":"Michael","family":"Goodman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet","family":"Turan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip","family":"Keiser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Seidel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren","family":"Raimer-Goodman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley","family":"Gitari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fridah","family":"Mukiri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Brault","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Premal","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,3]]},"reference":[{"key":"ref1","year":"2021"},{"key":"ref2","volume-title":"Kenya population-based HIV impact assessment (KENPHIA) 2018: Final report","year":"2022"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e25647","DOI":"10.1002\/jia2.25647","article-title":"Pathways for reduction of HIV-related stigma: a model derived from longitudinal qualitative research in Kenya and Uganda","volume":"23","author":"Camlin","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"e106","DOI":"10.1016\/S2352-3018(20)30309-X","article-title":"Stigma reduction: an essential ingredient to ending AIDS by 2030","volume":"8","author":"Nyblade","year":"2021","journal-title":"Lancet HIV"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1007\/s10461-019-02771-7","article-title":"Falling short of the first 90: HIV stigma and HIV testing research in the 90\u201390\u201390 era","volume":"24","author":"Sullivan","year":"2020","journal-title":"AIDS Behav"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e817","DOI":"10.1016\/S2352-3018(20)30198-3","article-title":"Perceived HIV stigma and HIV testing among men and women in rural Uganda: a population-based study","volume":"7","author":"Kalichman","year":"2020","journal-title":"Lancet HIV"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1007\/s10461-021-03374-x","article-title":"Maternal PrEP use in HIV-uninfected pregnant women in South Africa: role of stigma in PrEP initiation, retention and adherence","volume":"26","author":"Moran","year":"2022","journal-title":"AIDS Behav"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"559","DOI":"10.1002\/jia2.25559","article-title":"Stigma impedes HIV prevention by stifling patient\u2013provider communication about U= U","volume":"23","author":"Calabrese","year":"2020","journal-title":"J Int AIDS Soc"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1097\/QCO.0000000000000701","article-title":"Long-acting injectable HIV therapies: the next frontier","volume":"34","author":"Thornhill","year":"2021","journal-title":"Curr Opin Infect Dis"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/25741292.2018.1540378","article-title":"Policy failure and the policy-implementation gap: can policy support programs help?","volume":"2","author":"Hudson","year":"2022","journal-title":"Policy Design Prac"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1478-4505-10-2","article-title":"Aligning vertical interventions to health systems: a case study of the HIV monitoring and evaluation system in South Africa","volume":"10","author":"Kawonga","year":"2012","journal-title":"Heal Res Policy Syst"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12913-018-3500-4","article-title":"Understanding the persistence of vertical (stand-alone) HIV clinics in the health system in Uganda: a qualitative synthesis of patient and provider perspectives","volume":"18","author":"Zakumumpa","year":"2018","journal-title":"BMC Health Serv Res"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/1478-4491-11-26","article-title":"Vertical funding, non-governmental organizations, and health system strengthening: perspectives of public sector health workers in Mozambique","volume":"11","author":"Mussa","year":"2013","journal-title":"Hum Resour Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"273","DOI":"10.1016\/j.ijid.2020.09.011","article-title":"Ending the epidemic of HIV\/AIDS by 2030: will there be an endgame to HIV, or an endemic HIV requiring an integrated health systems response in many countries?","volume":"100","author":"Assefa","year":"2020","journal-title":"Int J Infect Dis"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1016\/S0140-6736(18)31466-1","article-title":"Beyond the silos: integrating HIV and global health","volume":"392","author":"Das","year":"2018","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"477","DOI":"10.1080\/03056244.2015.1064373","article-title":"Breaking out of silos\u2013the need for critical paradigm reflection in HIV prevention","volume":"42","author":"Parkhurst","year":"2015","journal-title":"Rev African Political Econ"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"756","DOI":"10.1002\/casp.2665","article-title":"Flourishing communities: a new model to promote sustainable community leadership and transformation in semi-rural Kenya","volume":"33","author":"Goodman","year":"2023","journal-title":"J Community Appl Soc Psychol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1765","DOI":"10.1093\/heapro\/daab018","article-title":"Come together to promote health: case study and theoretical perspectives from a Kenyan community-based program","volume":"36","author":"Goodman","year":"2021","journal-title":"Health Promot Int"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s42448-023-00156-x","article-title":"Partner cooperation, conflict, maternal mental health, and parenting Behaviors in rural Kenya: towards a two-generational understanding of gender transformation benefits","author":"Cox","year":"2023","journal-title":"Int J Child Maltreatment: Res Policy Pract"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1177\/0020764020966014","article-title":"Come together to decrease depression: Women\u2019s mental health, social capital, and participation in a Kenyan combined microfinance program","volume":"67","author":"Goodman","year":"2021","journal-title":"Int J Soc Psychiatry"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"3399","DOI":"10.1080\/17441692.2022.2095656","article-title":"Water insecurity, food insecurity and social capital associated with a group-led microfinance programme in semi-rural Kenya","volume":"17","author":"Goodman","year":"2022","journal-title":"Glob Public Health"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1007\/s10896-022-00391-9","article-title":"Child maltreatment, social capital, maternal mental health and duration of program involvement: assessment from a community-based empowerment program in Kenya","volume":"38","author":"Goodman","year":"2022","journal-title":"J Family Violence"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"593","DOI":"10.3389\/fpsyg.2023.1175593","article-title":"Enabling structural resilience of street-involved children and youth in Kenya: reintegration outcomes and the flourishing community model","volume":"14","author":"Goodman","year":"2023","journal-title":"Front Psychol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"101908","DOI":"10.1016\/j.cpr.2020.101908","article-title":"A process-based approach to psychological diagnosis and treatment: the conceptual and treatment utility of an extended evolutionary meta model","volume":"82","author":"Hayes","year":"2020","journal-title":"Clin Psychol Rev"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"17","DOI":"10.1037\/1089-2699.12.1.17","article-title":"For the good of the group? Exploring group-level evolutionary adaptations using multilevel selection theory","volume":"12","author":"O'Gorman","year":"2008","journal-title":"Group Dyn Theory Res Pract"},{"key":"ref26","first-page":"251","volume-title":"Building a process-based diagnostic system: An extended evolutionary approach","author":"Hayes","year":"2020"},{"key":"ref27","doi-asserted-by":"crossref","DOI":"10.4324\/9781315085241","volume-title":"The social psychology of prosocial behavior","author":"Dovidio","year":"2017"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1017\/S0140525X13001593","article-title":"Evolving the future: toward a science of intentional change","volume":"37","author":"Wilson","year":"2014","journal-title":"Behav Brain Sci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"260","DOI":"10.1080\/14616734.2021.1976921","article-title":"Enhancing the \u201cbroaden-and-build\u201d cycle of attachment security as a means of overcoming prejudice, discrimination, and racism","volume":"24","author":"Mikulincer","year":"2022","journal-title":"Attach Hum Dev"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"2054","DOI":"10.3390\/ijerph17062054","article-title":"Enhancing the \u201cbroaden and build\u201d cycle of attachment security in adulthood: from the laboratory to relational contexts and societal systems","volume":"17","author":"Mikulincer","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1080\/15575330609490152","article-title":"Spiraling-up: mapping community transformation with community capitals framework","volume":"37","author":"Emery","year":"2006","journal-title":"Community Dev"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1177\/1745691617692106","article-title":"Reflections on positive emotions and upward spirals","volume":"13","author":"Fredrickson","year":"2018","journal-title":"Perspec Psychol Sci"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"774","DOI":"10.1037\/a0034360","article-title":"Participatory and action research as a transformative praxis: responding to humanitarian crises from the margins","volume":"68","author":"Lykes","year":"2013","journal-title":"Am Psychol"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap consortium: building an international community of software platform partners","volume":"95","author":"Harris","year":"2019","journal-title":"J Biomed Inform"},{"key":"ref35","doi-asserted-by":"crossref","first-page":"772","DOI":"10.1007\/s10461-007-9340-6","article-title":"Assessing HIV\/AIDS stigma and discrimination in developing countries","volume":"12","author":"Genberg","year":"2008","journal-title":"AIDS Behav"},{"key":"ref36","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1007\/s10461-010-9798-5","article-title":"HIV\/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study","volume":"15","author":"Turan","year":"2011","journal-title":"AIDS Behav"},{"key":"ref37","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.3390\/ijerph15102139","article-title":"Collective efficacy: development and validation of a measurement scale for use in public health and development programmes","volume":"15","author":"Delea","year":"2018","journal-title":"Int J Environ Res Public Health"},{"key":"ref38","first-page":"1","article-title":"Positive emotions broaden and build","volume-title":"Advances in experimental social psychology","author":"Fredrickson","year":"2013"},{"key":"ref39","doi-asserted-by":"crossref","first-page":"920","DOI":"10.1177\/0146167218801363","article-title":"Causality in the theory of planned behavior","volume":"45","author":"Sussman","year":"2019","journal-title":"Pers Soc Psychol Bull"},{"key":"ref40","volume-title":"Stata Statistical Software: Release 16","year":"2019"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"39","DOI":"10.1080\/09540121.2016.1164808","article-title":"Factors associated with antiretroviral treatment initiation amongst HIV-positive individuals linked to care within a universal test and treat programme: early findings of the ANRS 12249 TasP trial in rural South Africa","volume":"28","author":"Boyer","year":"2016","journal-title":"AIDS Care"},{"key":"ref42","year":"2023"},{"key":"ref43","volume-title":"War in Ukraine, world food prices, and conflict in Africa","author":"McGuirk","year":"2022"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"133","DOI":"10.1038\/s43016-023-00702-3","article-title":"Responding to loss and damage in food systems","volume":"4","author":"Laganda","year":"2023","journal-title":"Nature Food"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"257","DOI":"10.1037\/a0026796","article-title":"The critical role of nurturing environments for promoting human well-being","volume":"67","author":"Biglan","year":"2012","journal-title":"Am Psychol"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1240200\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,3]],"date-time":"2023-11-03T10:26:47Z","timestamp":1699007207000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2023.1240200\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,3]]},"references-count":45,"alternative-id":["10.3389\/fpubh.2023.1240200"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2023.1240200","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,3]]},"article-number":"1240200"}}