404. Trends in HIV-related Stigma in the General Population During the Era of Antiretroviral Treatment Expansion: An Analysis of 31 Sub-Saharan African Countries
Session: Poster Abstract Session: HIV Engagement in Care and the Care Cascade
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • IDweek-stigmatrends-FINAL.pdf (504.2 kB)
  • Trends in HIV-related stigma in the general population during the era of antiretroviral treatment expansion: an analysis of 31 sub-Saharan African countries

    Chan BT, Tsai AC.

    Background: HIV-related stigma is an important public health problem because it is associated with increased risk-taking behavior, reduced uptake of HIV testing, and decreased adherence to antiretroviral therapy (ART). ART expansion may reduce HIV-related stigma through improvements in physical health among people living with HIV (PLHIV), which lead to economic rehabilitation and social reintegration. However, the extent to which levels of HIV-related stigma in the general population have changed during the current era of ART scale-up in sub-Saharan Africa is unknown.

    Methods: Data on HIV-related stigma in the general population, including stigmatizing attitudes and anticipated stigma, were drawn from the Demographic and Health Surveys (DHSs) and AIDS Indicator Surveys (AISs) of 31 sub-Saharan African countries between 2003-2013. We fitted linear regression models with robust standard errors and country fixed effects, specifying stigmatizing attitudes or anticipated stigma as the dependent variable and year as the explanatory variable; all estimates were adjusted for socio-demographic variables and HIV knowledge.

    Results: We found a statistically significant negative association between year and stigmatizing attitudes (adjusted b=-0.021; 95% CI, -0.028 to -0.015) but a statistically significant positive association between year and anticipated stigma (adjusted b=0.025; 95% CI, 0.019 to 0.031). Compared to the baseline mean across countries in 2003 (Figure 1), these regression coefficients suggested an approximately 4% reduction in prevalence of stigmatizing attitudes and 4% increase in prevalence of anticipated stigma with each year. Adjustment for HIV knowledge yielded no substantive changes to these findings.

    Conclusion: During a period of ART expansion in sub-Saharan Africa, anticipated stigma in the general population increased despite a decrease in stigmatizing attitudes towards PLHIV. Our findings suggest that ART expansion alone is insufficient to reduce HIV-related stigma. Further study is needed to understand the reasons for worsening anticipated stigma in the general population and to develop effective anti-stigma interventions.

    Brian Chan, MD, Infectious Diseases, Brigham and Women's Hospital, Boston, MA and Alexander Tsai, MD, PhD, Center for Global Health, Massachusetts General Hospital, Boston, MA

    Disclosures:

    B. Chan, None

    A. Tsai, None

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