HIV-related stigma is associated with increased risk-taking behavior, reduced uptake of HIV testing, and decreased adherence to antiretroviral therapy (ART). Although ART scale-up may reduce HIV-related stigma, the extent to which levels of stigma in the general population have changed during the era of ART scale-up in sub-Saharan Africa is unknown.
Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys (DHS) and AIDS Indicator Surveys (AIS) of 31 African countries between 2003-2013. We fitted multivariable linear regression models with cluster-correlated robust standard errors and country fixed effects, specifying social distance or anticipated stigma as the dependent variable and year as the primary explanatory variable of interest.
We estimated a statistically significant negative association between year and desires for social distance (b=-0.020; p<0.001; 95% Confidence Interval [CI], -0.026 to -0.015) but a statistically significant positive association between year and anticipated stigma (b=0.023; p<0.001; 95% CI, 0.018-0.027). In analyses stratified by HIV prevalence above or below the sample median, declines in social distancing over time were more pronounced among countries with a higher HIV prevalence. CONCLUSION
Concomitant with ART scale-up in sub-Saharan Africa, anticipated stigma in the general population increased despite a decrease in social distancing towards people living with HIV (PLHIV). Although ART scale-up may help reduce social distancing toward PLHIV, particularly in high-prevalence countries, other interventions targeting symbolic or instrumental concerns about HIV may be needed.