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
  • 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


    B. Chan, None

    A. Tsai, None

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