Evaluating the Effectiveness of Narrative Therapy in Reducing Shame and Stigma Among HIV-Positive Adults in Cross River State

Shame and stigma experienced by HIV-positive individuals in Nigeria significantly impair adherence to treatment, help-seeking, and quality of life, and evidence for the effectiveness of narrative therapy as a counselling approach to reducing HIV-related shame is needed in the South South context. This study evaluated the effectiveness of a narrative therapy intervention on shame and stigma outcomes among HIV-positive adults in Calabar, Cross River State. A pre-test post-test design with a comparison group was employed. Forty HIV-positive adults attending an ART clinic and reporting significant HIV-related shame (assessed using the HIV Stigma Scale) were assigned to the narrative therapy group (n=20) or standard care comparison group (n=20). The narrative therapy intervention comprised eight individual sessions focusing on externalising HIV stigma, re-authoring personal identity stories, and witnessing circles. Post-intervention assessments were conducted at 8 weeks and 4 months. Results showed significant reductions in internalised shame (p < 0.001), disclosure concerns (p < 0.001), and negative self-image (p < 0.001) in the narrative therapy group, with gains maintained at 4-month follow-up. ART adherence improved significantly in the therapy group (p < 0.05). The comparison group showed no significant change. The study provides preliminary evidence for narrative therapy effectiveness in reducing HIV-related shame in this population and recommends integration of narrative-focused counselling into HIV care services in Cross River State. Keywords: narrative therapy, HIV stigma, shame, Cross River State, HIV counselling