HIV stigma in Africa is not getting better, according to recent studies

Wednesday, October 15, 2014

Despite public education campaigns and progress in expanding availability of HIV medications in countries with high burdens, two recent studies have shown that HIV-related stigma in Africa is not going away. From this week's NAM aidsmap newsletter:
Many people hope that as HIV treatment becomes more widely available, people’s fear of HIV might decrease. But a study from rural Uganda, conducted between 2006 and 2012, is not encouraging on this point. Annual surveys with people living with HIV showed that concerns about disclosing HIV status and measures of internalised stigma had increased during this time. And surveys done with the general population showed that an increasing number of people said they would expect people living with HIV to experience stigma when disclosing their HIV status.

The second study was conducted with nearly 40,000 schoolchildren, aged 12 to 14 years, in nine southern African countries in 2007. In four countries, one-in-five children said that they would “avoid or shun” a friend who revealed that they had HIV. In three countries, over a third of students believed that children living with HIV should not be allowed to continue to attend school.

Children from poorer families and children living in rural areas were more likely to have stigmatising attitudes.
Interestingly, the first study - examining both internalized stigma among people living with HIV (PLHIV) and attitudes among the general population - found that while internalized stigma among PLHIV increased over the five-year study, attitudes regarding HIV among the general population actually improved:
Overall, participants in 2011 were more likely to have accepting attitudes towards HIV (59 vs 46%, p < 0.001).

However, in 2011 a higher proportion stated that they would expect people living with HIV to experience stigma when disclosing their status (61 vs 47%, p < 0.001).

The investigators offer two suggestions for this apparent disparity in their findings. First they suggest that answers about feelings of stigma towards HIV may have been affected by social desirability – participants provided researchers with the answers they thought they ought to. Alternatively, the authors suggest that attitudes towards HIV genuinely had changed among the study participants, but they perceived that the attitudes of others in their society had not.
The second study examined attitudes related to HIV among schoolchildren in Botswana, Lesotho, Malawi, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. Generally, the study found that students with more accurate knowledge about HIV and its modes of transmission were less likely to have discriminatory attitudes, and there were major differences in knowledge and attitudes between rich and poor students, and also between students in urban and rural areas, with rural and poorer students more likely to have discriminatory attitudes.
The two countries with the lowest scores for discriminatory attitudes, Malawi and to a lesser extent Swaziland, are small countries with high HIV prevalence that have mounted particularly strong public awareness campaigns and more recently have concentrated on providing access to antiretroviral therapy and, in the case of Malawi, especially to testing.

The researchers comment: “Our study points towards the need for early interventions (age 13 or before) to reduce stigma and discrimination among children, especially in schools in rural and poorer areas. In particular, interventions should aim to correct misconceptions that HIV can be transmitted via casual contact with people living with HIV.”
This should come as little surprise - similar studies have demonstrated that the better informed a population is about HIV, the less likely they are to have negative attitudes about it. Both studies underscore the continued need for public education campaigns about HIV, and that increasing the availability of medications, while important, should not take away from the need to inform the population.

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