Double Stigma Among Pregnant Adolescents Living With HIV in Northern Uganda: A Pilot Cross-Sectional Study

Abstract

Background Despite a global decline in HIV/AIDS incidence, adolescent girls and young women in sub-Saharan Africa remain disproportionately affected. Pregnant adolescents living with HIV/AIDS (ALWHIV) in Uganda may experience dual stigma from their HIV status and pregnancy. However, this remains unexplored, limiting targeted interventions. This study assessed the burden and factors associated with stigma among pregnant ALWHIV in Northern Uganda. Methods We analyzed baseline data from a pilot quasi-experimental study conducted between June and September 2023 at two tertiary hospitals to evaluate the feasibility of group therapy. All pregnant adolescents aged 10–19 with a confirmed diagnosis of HIV/AIDS were enrolled consecutively after informed consent. Stigma was determined using the HIV-stigma scale for children (HSS-10) and adolescent pregnancy stigma scale, and composite scores were normalized to a scale of 0–100 for comparison. Linear regression models were used to identify factors associated with HIV and pregnancy stigma in STATA 18.0. Results A total of 40 pregnant ALWHIV, 20 from each facility, were enrolled. The mean participant age was 18.2 years (SD: 0.9), 95% were school dropouts, and 60% were married or cohabiting. About 35% acquired HIV/AIDS perinatally, while 37.5% had a prior pregnancy. The median HIV-stigma score was 29/40 (IQR: 26–32), and the mean pregnancy stigma score was 46.5/75.0 (SD: 9.7). HIV stigma score was significantly higher than the adolescent pregnancy stigma score (median difference: 10.0%, p = 0.001), and pregnancy stigma had a strong positive correlation with HIV stigma (ρ = 0.67, p < 0.0001). HIV stigma was significantly associated with not living with a spouse/partner (adjusted β: 8.51, 95% CI: 0.17, 16.85, p = 0.046) and rural residence (β: 11.65, 95% CI: 2.36, 20.94, p = 0.046). Pregnancy stigma was significantly associated with not living with a spouse/partner (β: 15.51, 95% CI: 5.94, 25.08, p = 0.002) and not receiving support with domestic tasks at home (β: 13.84, 95% CI: 3.59, 24.08, p = 0.009). Conclusion Pregnant ALWHIV in our study faced significant stigma to HIV/AIDS and pregnancy, and this is significantly associated with not living with the marital partner. Those in rural settings also experienced higher HIV stigma, while those experiencing pregnancy stigma were more likely not to be receiving support with domestic tasks at home. Further research is needed on comprehensive support programs to alleviate the burden and enhance maternal and child health outcomes.