Persistent HIV-related stigma in rural Uganda during a period of increasing HIV incidence despite treatment expansion

Abstract

Objective Program implementers have argued that the increasing availability of anti-retroviral therapy (ART) will reduce the stigma of HIV. We analyzed data from Uganda to assess how HIV-related stigma has changed during a period of ART expansion. Design Serial cross-sectional surveys. Methods We analyzed data from the Uganda AIDS Rural Treatment Outcomes (UARTO) study during 2007-2012 to estimate trends in internalized stigma among people living with HIV (PLHIV) at the time of treatment initiation. We analyzed data from the Uganda Demographic and Health Surveys (DHS) from 2006 and 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We fitted regression models adjusted for socio-demographic characteristics, with year of data collection as the primary explanatory variable. Results We estimated an upward trend in internalized stigma among PLHIV presenting for treatment initiation (adjusted b=0.18; 95% CI, 0.06 to 0.30). In the general population, the odds of reporting anticipated stigma were greater in 2011 compared to 2006 (adjusted OR=1.80; 95% CI, 1.51 to 2.13), despite an apparent decline in stigmatizing attitudes (adjusted OR=0.62; 95% CI, 0.52 to 0.74). Conclusions Internalized stigma has increased over time among PLHIV in the setting of worsening anticipated stigma in the general population. Further study is needed to better understand the reasons for increasing HIV-related stigma in Uganda and its impact on HIV prevention efforts.

Socioeconomic Gradients in Internalized Stigma Among 4,314 Persons with HIV in Sub-Saharan Africa

“…A comparison of these estimates with large-sample studies conducted a decade earlier in Botswana and South Africa suggest comparable levels of social distancing and high levels of support for coercive measures [13,40,59–62]. Most recently, Chan et al [63] showed that internalized stigma among persons with HIV has increased in rural Uganda, in the context of concomitant increases in anticipated stigma in the general population. Thus, although the scale-up of HIV treatment appears to have lessened fears about HIV [3,15,39,40] and there is some evidence that stigmatizing attitudes have even declined in some countries [64], my estimates suggest that persons with HIV have yet to feel widespread acceptance in sub-Saharan Africa.…”

Proximate Context of HIV Stigma and Its Association with HIV Testing in Sierra Leone: A Population-Based Study

“…Stigmatizing attitudes may have changed since then. Studies in other countries in sub-Saharan Africa have shown both declines and increases in HIV stigma, so it is unclear whether changes in HIV stigmatizing attitudes in Sierra Leone would have biased our estimates toward or away from the null [14]. …”

HIV Treatment Scale-Up and HIV-Related Stigma in Sub-Saharan Africa: A Longitudinal Cross-Country Analysis

“…36 The DHS and AIS are nationally representative, population-based surveys conducted approximately every 5 years in more than 90 low- and middle-income countries worldwide. Standardization of DHS–AIS questions permits the analysis of trends in attitudes and behaviors within countries over time 37 as well as comparative analyses across countries. 38 Details of the DHS–AIS sampling procedures are included on the DHS Web site and in published country-level reports.…”