Awareness, acceptance, and action: an emerging framework for understanding AIDS stigmatizing attitudes among community leaders in Barbados.

AIDS stigma must be acknowledged and reduced to advance HIV prevention and HIV/AIDS care in a variety of settings worldwide, including in the West Indies where national epidemics are thought to be growing rapidly. Regarded by international health organizations as a formidable barrier to service delivery and receipt, AIDS stigma refers to prejudice and discrimination directed toward people living with HIV/AIDS (PLHA), persons perceived as being at risk for HIV infection, and the informal and formal service providers who care for PLHA. However, there is little evidence of successful antistigma interventions in the literature. Furthermore, beyond studies of willingness in various professions to serve clients or patients with HIV/AIDS, the stigmatizing attitudes and behaviors of service delivery personnel, paraprofessionals and volunteers have been inadequately studied. This paper uses data obtained during an AIDS awareness workshop with sports coaches in Barbados to illustrate principles of an antistigma intervention framework being developed for social service and health personnel. The Awareness/Acceptance/Action Model (AAAM) draws on principles of mindfulness, rooted in ancient Asian traditions, and recently adapted to a range of physical and mental health interventions in Western contexts. Mindfulness techniques encourage awareness of one's current state and environment, acceptance of the implications of one's attitudes and behaviors, and the development of intentional responses rather than habitually patterned reactions. In this initial effort, community leaders were guided through a series of self-reflective exercises focusing AAAM principles on their tendencies toward AIDS stigma, and exploring more compassionate and functional alternatives.