Individual and community-level risk factors for HIV stigma in 21 Zambian and South African communities

Abstract

Objectives Describe the prevalence and determinants of HIV stigma in 21 communities in Zambia and South Africa. Design Analysis of baseline data from the HPTN 071 (PopART) cluster-randomised 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 (n=851). Methods We calculated the prevalence of internalised 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. Results Internalised 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<0.001), and those with more lifetime sexual partners (p<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 where community members perceived higher levels of stigma, but was not associated with the beliefs of community members or health workers. Conclusions 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.

Understanding the Time Needed to Link to Care and Start ART in Seven HPTN 071 (PopART) Study Communities in Zambia and South Africa

“…The social context and HIV services in all the communities in both countries have been described elsewhere [ 38 ]. An ancillary study on stigma was undertaken, which provides additional information on stigma experiences in health facilities and levels of stigma in different communities, also described elsewhere [ 35 , 39 , 40 ].…”

“…Some factors resulting in delayed uptake of ART are linked to broader health service delivery challenges that impede progress in providing treatment to everyone living with HIV, including access to and availability of drugs [ 29 – 33 ]. The barriers to treatment associated with the health service may be compounded by, for example, the persistence of HIV-related stigma which affects a person’s ability to access care and other demands on time due to making a livelihood or caring for children at home [ 34 , 35 ].…”

Association between HIV stigma and antiretroviral therapy adherence among adults living with HIV: baseline findings from the HPTN 071 (PopART) trial in Zambia and South Africa

“…HIV stigma can undermine ART adherence [12][13][14][15][16][17] and is a frequently reported barrier to adherence in sub-Saharan Africa [13]. HIV stigma is common in both Zambia and South Africa, with over 35% of PLHIV reporting some type of stigma [18]. Whilst ART adherence is consistently found to be worse among individuals experiencing stigma than among those who do not [19][20][21][22][23][24][25], a 2013 review concluded that all but one study was at risk of bias, and most had not used validated exposure or outcome measures [19].…”

“…To create the three variables, respondents who disagreed or never experienced stigma on all the questions related to that variable were grouped as 'never experiencing' that type of stigma. Those agreeing or experiencing stigma on ≥1 question were categorised as 'ever experiencing' that type of stigma [18]. Our stigma measures were aligned with standardised measures that were approved by the UNAIDS' monitoring and evaluation reference group (MERG) in 2014 [18,28,29].…”

Thetha Nami: Participatory development of a peer-navigator intervention to deliver biosocial HIV prevention for adolescents and young men and women in rural South Africa

“…Our study show that internalised and externalised HIV stigma and social norms around adolescent and youth sexuality remain a huge challenge to delivering HIV prevention, even in these high HIV burden rural settings [35][36][37]. Young people involved in this research brought a nuanced understanding of the intersection between poverty and lack of opportunity, and the gender and intergenerational power imbalances to the intervention development process [38,39].…”