Individual and community-level risk factors for HIV stigma in 21 Zambian and South African communities: analysis of data from the HPTN071 (PopART) study

James R Hargreaves, Shari Krishnaratne, Hlengani Mathema, Pamela S Lilleston, Kirsty Sievwright, Nomtha Mandla, Tila Mainga, Redwaan Vermaak, Estelle Piwowar-Manning, Ab Schaap, Deborah Donnell, Helen Ayles, Richard J Hayes, Graeme Hoddinott, Virginia Bond, Anne Stangl, HPTN 071 (PopART) Study Team, James R Hargreaves, Shari Krishnaratne, Hlengani Mathema, Pamela S Lilleston, Kirsty Sievwright, Nomtha Mandla, Tila Mainga, Redwaan Vermaak, Estelle Piwowar-Manning, Ab Schaap, Deborah Donnell, Helen Ayles, Richard J Hayes, Graeme Hoddinott, Virginia Bond, Anne Stangl, HPTN 071 (PopART) Study Team

Abstract

Objective: To 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-randomized 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 (HW) (n = 851).

Methods: We calculated the prevalence of internalized 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: Internalized 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 wherever community members perceived higher levels of stigma, but was not associated with the beliefs of community members or HW.

Conclusion: 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.

Figures

Fig. 1
Fig. 1
Cluster-level scatter plots showing the association between the beliefs and perceptions of community members and health workers not living with HIV and levels of (a) internalized stigma and experienced community stigma, and (b) experienced healthcare setting stigma reported by people living with HIV in 21 communities in South Africa and Zambia.

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