Infectious Disease · Medical Literature
Social Media Messaging to Reduce HIV-Related Stigma Among Young Adults in Peru: A Randomized Controlled Study.
Abstract
HIV-related stigma undermines prevention and treatment efforts, particularly among young adults. Social media offers a scalable platform for stigma-reduction efforts; however, empirical evidence of its effectiveness remains limited. Social media influencers may enhance the effectiveness of stigma reduction messages delivered via social media. From November 2024 to January 2025, we conducted a randomized controlled study in Lima, Peru, among young adults aged 18-29 years to evaluate the impact of brief exposure to tailored social media content designed to reduce HIV-related stigma. Content featured widely recognized Peruvian influencers or young adult residents filmed in recognizable places in Lima. Participants were randomized to a simulated social media feed containing one of four HIV stigma-reduction videos, including one featuring a top Peruvian influencer, or a control video. Stigma was evaluated using the Bogardus social distance scale, scored using standard and intensity-based methods. Five hundred and sixty-seven persons participated (53% male, median age: 21 years). Median social distance pre-randomization score was 1 in controls (fifth-95th percentile: 1-7), 1 in Arm 1 (fifth-95th: 1-7), 1 in Arm 2 (fifth-95th: 1-6), 1 in Arm 3 (fifth-95th: 1-5) and 1 in Arm 4 (fifth-95th: 1-7). Comparisons of pre- and post-changes by study arm supported modest intervention effects. Controls showed a median change of 0 (fifth-95th: -1-2). Arm 1, featuring influencer-generated content, showed a median change of 0 (fifth-95th: -6-0), with a Wilcoxon rank-sum test indicating a statistically significant difference from controls (p = 0.001). Arm 2 showed a median change of 0 (fifth-95th: -1-0, p = 0.08). Arm 3 showed a median change of 0 (fifth-95th: -2-0, p = 0.01). Arm 4 showed a median change of 0 (fifth-95th: -3-0, p = 0.01). Brief exposure to culturally tailored social media content led to modest reductions in HIV-related stigma among young adults in Peru immediately after viewing. Findings reinforce the potential role of social media and influencers in HIV stigma reduction efforts. Future research should examine whether social media interventions can reduce stigma among those with the most stigmatizing beliefs and identify dosing and delivery strategies that achieve durable reductions in stigma.
Clinical relevance
HIV-related stigma remains a critical structural barrier to both prevention uptake and treatment engagement, disproportionately affecting young adults in Latin American settings such as Peru where cultural and social norms amplify discrimination. This RCT addresses a well-recognized evidence gap regarding scalable, low-cost digital interventions for stigma reduction, leveraging social media platforms already embedded in the daily lives of the 18–29-year-old demographic. Clinicians and public health specialists working in HIV prevention should note these findings as social media-based stigma reduction could serve as a feasible adjunct to existing community-level and clinical interventions.
Key findings
1. A total of 567 young adults (53% male, median age 21 years) in Lima, Peru were randomized across four intervention arms and one control arm in a November 2024–January 2025 RCT evaluating brief exposure to tailored HIV stigma-reduction social media videos. 2. Baseline HIV-related stigma, measured via the Bogardus Social Distance Scale, was low and equivalent across all arms (median score = 1 in all groups), indicating a floor effect at baseline that limited measurable pre-post change. 3. Arm 1 (influencer-generated content featuring a top Peruvian influencer) demonstrated a statistically significant reduction in social distance scores compared to controls (Wilcoxon rank-sum p = 0.001), with a median change of 0 and a notably wider negative distribution (5th–95th percentile: −6 to 0) versus controls (5th–95th percentile: −1 to 2). 4. Arms 3 and 4 (non-influencer tailored content) each showed statistically significant reductions in stigma versus controls (both p = 0.01), with 5th–95th percentile ranges of −2 to 0 and −3 to 0, respectively, suggesting modest but real intervention effects. 5. Arm 2 did not reach statistical significance compared to controls (median change 0, 5th–95th percentile: −1 to 0; p = 0.08), indicating differential effectiveness across content formats. 6. No effect sizes (e.g., Cohen's d), confidence intervals, or NNT/NNH values were reported in the abstract; all between-group comparisons were derived from nonparametric Wilcoxon rank-sum testing, reflecting the non-normal, ordinal distribution of the Bogardus scale scores.
Practice implications
Public health clinicians and HIV program implementers should consider integrating culturally tailored, influencer-driven social media content into existing stigma-reduction campaigns targeting young adults (18–29 years), particularly in urban Latin American settings, as this format demonstrated the strongest and most statistically robust stigma-reduction signal. Given the floor effect observed at baseline and the modest magnitude of change, this intervention appears most promising as a population-level priming tool rather than a standalone solution, and future programs should prioritize delivery to subpopulations with elevated baseline stigmatizing attitudes where effect sizes may be larger. Longitudinal follow-up and optimization of dosing frequency and content sequencing are urgently needed before this approach can be recommended as a durable, scalable component of HIV stigma-reduction programming.