Evaluating a Multi-Level Stigma Reduction Intervention for Healthcare Workers and Community Leaders in Nigerian HIV Clinics: A Mixed-Methods Study

**Revised Abstract**

HIV-related stigma within healthcare settings and communities remains a significant barrier to achieving epidemic control in sub-Saharan Africa. This study evaluated a multi-level, 12-month stigma reduction intervention in six Nigerian HIV clinics from 2023 to 2024. The intervention comprised structured participatory training for healthcare workers and facilitated dialogue sessions with community leaders. A concurrent mixed-methods design was employed. Quantitative data were collected using validated scales measuring stigmatising attitudes and behaviours at baseline (n=312) and post-intervention (n=298), analysed via paired t-tests. Qualitative data from 42 in-depth interviews and six focus group discussions with participants were thematically analysed to capture experiential changes and contextual understanding. Integration of data strands occurred during interpretation. Findings demonstrated a statistically significant reduction in stigmatising attitudes among healthcare workers (p<0.01), particularly regarding fears of casual transmission. Community leaders reported increased advocacy and proactive countering of misinformation. Qualitative analysis generated key themes of improved client-provider interactions and the catalytic role of community leadership in shifting normative beliefs. The study concludes that concurrently addressing institutional and community stigma amplifies intervention impact, providing a replicable model for integrating social and clinical HIV responses. These findings directly inform the implementation of Nigeria’s National HIV/AIDS Strategic Plan, underscoring the necessity of sustained investment in multi-level approaches to foster equitable, stigma-free healthcare environments.