Persistent HIV-Related Stigma in Rural Uganda During a Period of Increasing HIV Incidence Despite Treatment Expansion

OBJECTIVE:

Programme implementers have argued that the increasing availability of antiretroviral 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.

METHODS:

We analyzed data from the Uganda AIDS Rural Treatment Outcomes 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 from 2006 to 2011 to estimate trends in stigmatizing attitudes and anticipated stigma in the general population. We fitted regression models adjusted for sociodemographic 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% confidence interval (CI), 0.06-0.30]. In the general population, the odds of reporting anticipated stigma were greater in 2011 compared with 2006 [adjusted odds ratio (OR) = 1.80; 95% CI, 1.51-2.13], despite an apparent decline in stigmatizing attitudes (adjusted OR = 0.62; 95% CI, 0.52-0.74).

CONCLUSION:

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.

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By:  Chan BT1, Weiser SD, Boum Y, Siedner MJ, Mocello AR, Haberer JE, Hunt PW, Martin JN, Mayer KH, Bangsberg DR, Tsai AC.

• 1aDivision of Infectious Diseases, Massachusetts General Hospital bDivision of Infectious Diseases, Brigham and Women's Hospital cHarvard Medical School, Boston, Massachusetts dDivision of HIV/AIDS, San Francisco General Hospital, University of California at San Francisco (UCSF) eCenter for AIDS Prevention Studies, UCSF, San Francisco, California, USA fEpicentre, Mbarara, Uganda gMassachusetts General Hospital Center for Global Health, Boston, Massachusetts hDepartment of Epidemiology and Biostatistics, UCSF, San Francisco, California iDivision of Infectious Diseases, Beth Israel Deaconess Medical Center jFenway Health, Boston, Massachusetts, USA kMbarara University of Science and Technology, Mbarara, Uganda lChester M. Pierce, MD Division of Global Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA. 

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