Individual and community-level risk factors for HIV stigma in 21 Zambian and South African communities: analysis of data from the HPTN071 (PopART) study.


Hargreaves, JR; Krishnaratne, S; Mathema, H; Lilleston, PS; Sievwright, K; Mandla, N; Mainga, T; Vermaak, R; Piwowar-Manning, E; Schaap, A; Donnell, D; Ayles, H; Hayes, RJ; Hoddinott, G; Bond, V; Stangl, A; HPTN 071 (PopART) Study Team, ; (2018) Individual and community-level risk factors for HIV stigma in 21 Zambian and South African communities: analysis of data from the HPTN071 (PopART) study. AIDS (London, England), 32 (6). pp. 783-793. ISSN 0269-9370 DOI: https://doi.org/10.1097/QAD.0000000000001757

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Abstract

: To describe the prevalence and determinants of HIV stigma in 21 communities in Zambia and South Africa.<br/> : Analysis of baseline data from the HPTN 071 (PopART) cluster-randomized trial. HIV stigma data came from a random sample of 3859 people living with HIV. Community-level exposures reflecting HIV fears and judgements and perceptions of HIV stigma came from a random sample of community members not living with HIV (n = 5088), and from health workers (HW) (n = 851).<br/> : We calculated the prevalence of internalized stigma, and stigma experienced in the community or in a healthcare setting in the past year. We conducted risk-factor analyses using logistic regression, adjusting for clustering.<br/> : Internalized stigma (868/3859, prevalence 22.5%) was not associated with sociodemographic characteristics but was less common among those with a longer period since diagnosis (P = 0.043). Stigma experienced in the community (853/3859, 22.1%) was more common among women (P = 0.016), older (P = 0.011) and unmarried (P = 0.009) individuals, those who had disclosed to others (P &lt; 0.001), and those with more lifetime sexual partners (P &lt; 0.001). Stigma experienced in a healthcare setting (280/3859, 7.3%) was more common among women (P = 0.019) and those reporting more lifetime sexual partners (P = 0.001) and higher wealth (P = 0.003). Experienced stigma was more common in clusters wherever community members perceived higher levels of stigma, but was not associated with the beliefs of community members or HW.<br/> : HIV stigma remains unacceptably high in South Africa and Zambia and may act as barrier to HIV prevention and treatment. Further research is needed to understand its determinants.<br/>

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Faculty of Public Health and Policy > Dept of Global Health and Development
Faculty of Public Health and Policy > Dept of Social and Environmental Health Research
Faculty of Infectious and Tropical Diseases > Dept of Clinical Research
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
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PubMed ID: 29369164
Web of Science ID: 427976500012
URI: http://researchonline.lshtm.ac.uk/id/eprint/4646237

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