Mbers. Internalized stigma is the negative self-image PLWHA may have resulting from perceived and/ or experienced stigma. An alternative framework assumes that HIV stigma begins at the societal level where inequalities in social, political, and economic power enable stigmatization.5 In this framework, HIV stigma can be manifested by labeling, negatively stereotyping, separating PLWHA from non-infected community members based on other discredited attributes (e.g., being an injection drug user or a commercial sex worker), and by racism and sexism. In this understanding, the most direct level of HIV stigma is experienced stigma, which can be acts of discrimination by non-stigmatized individuals or acts of discrimination toward PLWHA at the institutional level (e.g., being fired for having HIV). Another useful theoretical framework incorporates both perceived and experienced stigma at the individual and community levels, in addition to internalized stigma.10 Moreover, this framework includes two new concepts of HIV stigma: felt normative stigma and vicarious stigma. Felt normative stigma is a protective mechanism for PLWHA against experiencing stigma (e.g., passing as a member of the non-stigmatized community). Vicarious stigma happens when PLWHA hear stories of experienced stigma and these stories become real to them, even though they may not have directly experienced discrimination themselves. Our study is one element of a Sitravatinib mechanism of action larger community-based project called Project EAST (Education and Access to Services and Testing) that is examining individual, provider, and community level factors that influence participation of rural racial/ethnic minorities in HIV/ AIDS research, and which will test the feasibility of implementing HIV/AIDS clinical trials in local Luteolin 7-glucoside site communities. The first phase of Project EAST utilized qualitative methods to obtain preliminary data about community views of HIV/AIDS and to ascertain the feasibility of clinical trial implementation in rural, minority communities. One mode of implementation that was highlighted was using a mobile unit to increase rural communities’ access to clinical trials. Issues of HIV stigma were dominant and emergent themes in this inquiry. Thus, the purpose of the current study–using the existing theoretical constructs for HIV stigma as a guide–was to develop a conceptual model that explored the relationship between HIV stigma and related identified themes, and how these themes may affect the implementation of HIV clinical trials in rural counties of North Carolina.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript MethodsSampleAccording to the 2000 US Census Bureau, almost 32 of the population in North Carolina lives in what is defined as a “rural area.”11 We conducted focus groups with HIV service providers and community leaders, and individual in-person interviews with PLWHA in six of these predominantly rural counties in North Carolina, representing two three-county communities. Moreover, these six counties were also selected due to their moderate HIV prevalence, based on HIV/AIDS surveillance at the end of 2007, ranging from 0.5 -1 .3 In qualitative methodology, sample size and power depend on purposeful selection of participants to achieve an information-rich and heterogeneous sample that represents theN C Med J. Author manuscript; available in PMC 2011 February 11.Sengupta et al.Pagetarget populations of interest;12 in our case, we were interested in sampling HIV.Mbers. Internalized stigma is the negative self-image PLWHA may have resulting from perceived and/ or experienced stigma. An alternative framework assumes that HIV stigma begins at the societal level where inequalities in social, political, and economic power enable stigmatization.5 In this framework, HIV stigma can be manifested by labeling, negatively stereotyping, separating PLWHA from non-infected community members based on other discredited attributes (e.g., being an injection drug user or a commercial sex worker), and by racism and sexism. In this understanding, the most direct level of HIV stigma is experienced stigma, which can be acts of discrimination by non-stigmatized individuals or acts of discrimination toward PLWHA at the institutional level (e.g., being fired for having HIV). Another useful theoretical framework incorporates both perceived and experienced stigma at the individual and community levels, in addition to internalized stigma.10 Moreover, this framework includes two new concepts of HIV stigma: felt normative stigma and vicarious stigma. Felt normative stigma is a protective mechanism for PLWHA against experiencing stigma (e.g., passing as a member of the non-stigmatized community). Vicarious stigma happens when PLWHA hear stories of experienced stigma and these stories become real to them, even though they may not have directly experienced discrimination themselves. Our study is one element of a larger community-based project called Project EAST (Education and Access to Services and Testing) that is examining individual, provider, and community level factors that influence participation of rural racial/ethnic minorities in HIV/ AIDS research, and which will test the feasibility of implementing HIV/AIDS clinical trials in local communities. The first phase of Project EAST utilized qualitative methods to obtain preliminary data about community views of HIV/AIDS and to ascertain the feasibility of clinical trial implementation in rural, minority communities. One mode of implementation that was highlighted was using a mobile unit to increase rural communities’ access to clinical trials. Issues of HIV stigma were dominant and emergent themes in this inquiry. Thus, the purpose of the current study–using the existing theoretical constructs for HIV stigma as a guide–was to develop a conceptual model that explored the relationship between HIV stigma and related identified themes, and how these themes may affect the implementation of HIV clinical trials in rural counties of North Carolina.NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript MethodsSampleAccording to the 2000 US Census Bureau, almost 32 of the population in North Carolina lives in what is defined as a “rural area.”11 We conducted focus groups with HIV service providers and community leaders, and individual in-person interviews with PLWHA in six of these predominantly rural counties in North Carolina, representing two three-county communities. Moreover, these six counties were also selected due to their moderate HIV prevalence, based on HIV/AIDS surveillance at the end of 2007, ranging from 0.5 -1 .3 In qualitative methodology, sample size and power depend on purposeful selection of participants to achieve an information-rich and heterogeneous sample that represents theN C Med J. Author manuscript; available in PMC 2011 February 11.Sengupta et al.Pagetarget populations of interest;12 in our case, we were interested in sampling HIV.