Abstract
The extent to which HIV stigma at the community level remains a barrier to greater uptake in HIV testing services is poorly understood. We used nationally representative data from the 2008 Sierra Leone Demographic and Health Survey. The primary outcome was HIV testing (past 12 months). Our explanatory variable was HIV stigmatizing attitudes (5-item scale). After multivariable adjustment, HIV testing had an inverse association with HIV stigmatizing attitudes measured at the individual [adjusted odds ratio (AOR) 0.94; 95 % CI 0.87–1.01] and community level (AOR 0.70; 95 % CI 0.58–0.85). HIV stigma had a stronger negative association with HIV testing when modeled at the community rather than individual level.
References
Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57. doi:10.1016/S0140-6736(08)61697-9.
Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505. doi:10.1056/NEJMoa1105243.
Gari S, Doig-Acuña C, Smail T, Malungo JR, Martin-Hilber A, Merten S. Access to HIV/AIDS care: a systematic review of socio-cultural determinants in low and high income countries. BMC Health Serv Res. 2013;13:198. doi:10.1186/1472-6963-13-198.
Tsai AC. Socioeconomic gradients in internalized stigma among 4314 persons with HIV in sub-Saharan Africa. AIDS Behav. 2015;19(2):270–82.
Young SD, Hlavka Z, Modiba P, et al. HIV-related stigma, social norms, and HIV testing in Soweto and Vulindlela, South Africa: National Institutes of Mental Health Project Accept (HPTN 043). J Acquir Immune Defic Syndr. 2010;55(5):620–4. doi:10.1097/QAI.0b013e3181fc6429.
Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall, Inc.; 1963.
Gilmore N, Somerville MA. Stigmatization, scapegoating and discrimination in sexually transmitted diseases: overcoming ‘them’ and ‘us’. Soc Sci Med. 1994;39(9):1339–58.
Hatzenbuehler ML. The social environment and suicide attempts in lesbian, gay, and bisexual youth. Pediatrics. 2011;127(5):896–903. doi:10.1542/peds.2010-3020.
Stephenson R, MiriamElfstrom K, Winter A. Community influences on married men’s uptake of HIV testing in eight African countries. AIDS Behav. 2013;17(7):2352–66. doi:10.1007/s10461-012-0223-0.
Konkle-Parker D. Community-level HIV stigma is a public health threat. HIV Clin. 2013;25(2):7–9.
Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc. 2013;16(3 Suppl 2):18734. doi:10.7448/IAS.16.3.18734.
Tsai AC, Bangsberg DR, Bwana M, et al. How does antiretroviral treatment attenuate the stigma of HIV? Evidence from a cohort study in rural Uganda. AIDS Behav. 2013;17(8):2725–31. doi:10.1007/s10461-013-0503-3.
Maman S, van Rooyen H, Stankard P, et al. NIMH Project Accept (HPTN 043): results from in-depth interviews with a longitudinal cohort of community members. PLoS One. 2014;9(1):e87091. doi:10.1371/journal.pone.0087091.
Chan BT, Weiser SD, Boum Y, et al. Persistent HIV-related stigma in rural Uganda during a period of increasing HIV incidence despite treatment expansion. AIDS. 2015;29(1):83–90. doi:10.1097/QAD.0000000000000495.
Filmer D, Pritchett LH. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography. 2011;38(1):115–32.
Acknowledgments
We would like to thank Measure DHS for access and authorization to the 2008 Sierra Leone Demographic Health Survey data files for research purposes. The authors received no specific funding for this study. ACT acknowledges salary support through the U.S. National Institutes of Health K23MH096620 and the Robert Wood Johnson Health and Society Scholars Program. SDW acknowledges salary support through the Hellman Family Foundation and Burke Family Foundation.
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Kelly, J.D., Weiser, S.D. & Tsai, A.C. Proximate Context of HIV Stigma and Its Association with HIV Testing in Sierra Leone: A Population-Based Study. AIDS Behav 20, 65–70 (2016). https://doi.org/10.1007/s10461-015-1035-9
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DOI: https://doi.org/10.1007/s10461-015-1035-9