Social Support, Food Insecurity, and HIV Stigma Among Men Living with HIV in Rural Southwestern Uganda: A Cross-Sectional Analysis

Abstract

Background HIV stigma is one of the major barriers to HIV care due to the fear of disclosure and social discrimination. HIV stigma among men in sub-Saharan countries, including Uganda, has been linked to the fear about how HIV status might affect their status in society. HIV among men in sub-Saharan settings has been associated with feelings of shame, reduced self-worth, and self-blame for their HIV positive status. Information about HIV stigma and its associated factors among men living with HIV in rural Uganda is limited. This study assessed the burden of HIV stigma and its association with social support and food insecurity among men accessing HIV care at a rural health facility in southwestern Uganda. Methods We conducted a clinic-based cross-sectional study and consecutively enrolled 252 adult men accessing HIV care at a rural health centre in southwestern Uganda. We collected information on sociodemographic information, HIV stigma, social support, and food insecurity. We fitted modified Poisson regression models to determine the associations between social support, food insecurity, and HIV stigma. Results The mean HIV stigma score of the study participants was 70.08 (SD 19.34) and 75% reported food insecurity 5% of whom were severely food insecure. The risk of HIV stigma was lower among those aged 35 years and above (adjusted risk ratio [ARR]=0.89; 95% CI 0.83–0.96; P=0.003, those who had been on ART for more than 5 years (ARR=0.92; 95% CI=0.84–0.99; P=0.04), and those who had social support (ARR=0.99; 95% CI=0.98–0.99; P=<0.001). Food insecurity was associated with an increased risk of HIV stigma (ARR=1.07; 95% CI 1.00–1.15; P=0.03). Social support moderated the effect of food insecurity on HIV stigma (P=0.45). Conclusion Stigma is common among men living with HIV in rural Uganda and is significantly associated with food insecurity. Social support moderated the effect of severe food insecurity on HIV stigma among men living with HIV. Interventions to build social support systems and to economically empower men living with HIV should be incorporated into the mainstream HIV care clinics.

Does resource insecurity drive HIV‐related stigma? Associations between food and housing insecurity with HIV‐related stigma in cohort of women living with HIV in Canada

“…This suggests that resource insecurity-related factors increase exposure to HIV-related stigma. These findings corroborate research on associations between HIV-related stigma and food insecurity in both high-income [2,7,33] and low-and middle-income contexts [25,26], and between HIV-related stigma and housing insecurity in high-income contexts [22]. Despite calls to harness poverty alleviation to reduce HIV-related stigma in sub-Saharan Africa nearly a decade ago [34], there is limited research on poverty and resource scarcities as stigma drivers in sub-Saharan Africa, particularly with WLHIV who are most impacted by the pandemic.…”

“…A cross-sectional study in Canada found that concurrent food and housing insecurity was associated with increased HIV-related stigma among women living with HIV (WLHIV) [24]. Food insecurity was also associated with increased internalized HIV-related stigma among WLHIV in the United States [7] and higher HIV-related stigma among PLHIV in Uganda [25,26]. Together, these studies signal the need to better understand associations between food and housing insecurity with HIV-related stigma.…”

The Optimization of HIV Testing in Eastern Indonesia: Findings from the 2017 Indonesian Demographic and Health Survey

“…This indicates the gap in the utilization of health services, such as PHCs, between urban and rural areas. In line with the previous studies, a further barrier to accessing HIV-related care was revealed, as it is dependent on the facility and social support available [ 17 , 18 , 19 , 20 ]. Eastern Indonesia has more rural demographic characteristics, as well as restricted transportation, information sources, and economic growth [ 21 , 22 , 23 ].…”

Telling the story of intersectional stigma in HIV‐associated Kaposi's sarcoma in western Kenya: a convergent mixed‐methods approach

“…Using quantitative evaluation of stigma alone, without the mixed-methods approach used in this analysis, therefore, could potentially underestimate the burden of stigma in this context. Other studies quantitatively evaluating HIV stigma in the African context are mixed: some studies found universally high stigma for people living with HIV, while others found, similar to our study, low overall stigma [20,33,34]. Findings of overall low HIV stigma could be due to underreporting related to social desirability bias, cultural attitudes towards stigma in western Kenya or poor performance of adapted Berger-aHSS scales in our context [34].…”