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. 2016 Aug 15;72(5):558-64.
doi: 10.1097/QAI.0000000000001011.

HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003-2013

Brian T Chan  1 , Alexander C Tsai
Affiliations

HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003-2013

Brian T Chan et al. J Acquir Immune Defic Syndr. .

Abstract

Background: HIV-related stigma is associated with increased risk-taking behavior, reduced uptake of HIV testing, and decreased adherence to antiretroviral therapy (ART). Although ART scale-up may reduce HIV-related stigma, the extent to which levels of stigma in the general population have changed during the era of ART scale-up in sub-Saharan Africa is unknown.

Methods: Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys and AIDS Indicator Surveys of 31 African countries between 2003 and 2013. We fitted multivariable linear regression models with cluster-correlated robust standard errors and country fixed effects, specifying social distance or anticipated stigma as the dependent variable and year as the primary explanatory variable of interest.

Results: We estimated a statistically significant negative association between year and desires for social distance (b = -0.020; P < 0.001; 95% confidence interval: -0.026 to -0.015) but a statistically significant positive association between year and anticipated stigma (b = 0.023; P < 0.001; 95% confidence interval: 0.018 to 0.027). In analyses stratified by HIV prevalence above or below the sample median, declines in social distancing over time were more pronounced among countries with a higher HIV prevalence.

Conclusions: Concomitant with ART scale-up in sub-Saharan Africa, anticipated stigma in the general population increased despite a decrease in social distancing toward people living with HIV. Although ART scale-up may help reduce social distancing toward people living with HIV, particularly in high-prevalence countries, other interventions targeting symbolic or instrumental concerns about HIV may be needed.

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Conflict of interest statement

Conflicts of Interest: The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
a: Trends in prevalence of desires for social distance in 13 countries with high HIV prevalence and multiple DHS/AIS, 2003–2013; by country b: Trends in prevalence of desires for social distance in 11 countries with low HIV prevalence and multiple DHS/AIS, 2003–2013; by country
Figure 1
Figure 1
a: Trends in prevalence of desires for social distance in 13 countries with high HIV prevalence and multiple DHS/AIS, 2003–2013; by country b: Trends in prevalence of desires for social distance in 11 countries with low HIV prevalence and multiple DHS/AIS, 2003–2013; by country
Figure 2
Figure 2
a: Trends in prevalence of anticipated stigma in 13 countries with high HIV prevalence and multiple DHS/AIS, 2003–2013; by country b: Trends in prevalence of anticipated stigma in 12 countries with low HIV prevalence and multiple DHS/AIS, 2003–2013; by country
Figure 2
Figure 2
a: Trends in prevalence of anticipated stigma in 13 countries with high HIV prevalence and multiple DHS/AIS, 2003–2013; by country b: Trends in prevalence of anticipated stigma in 12 countries with low HIV prevalence and multiple DHS/AIS, 2003–2013; by country
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