Media saturation, communication exposure and HIV stigma in Nigeria

Department of Health, Behavior and Society, Johns Hopkins University, Baltimore, MD 21202, USA.
Social Science & Medicine (Impact Factor: 2.89). 03/2009; 68(8):1513-20. DOI: 10.1016/j.socscimed.2009.01.026
Source: PubMed

ABSTRACT HIV-related stigma constitutes an impediment to public health as it hampers HIV/AIDS control efforts in many ways. To address the complex problems of increasing HIV infection rate, widespread misinformation about the infection and the rising level of HIV-related stigma, the various tiers of government in Nigeria are working with local and international non-governmental organizations to develop and implement strategic communication programs. This paper assesses the link between these communication efforts and HIV-related stigma using data from a nationally representative household survey. The results show that accepting attitudes towards people living with HIV are more prevalent among men than among women. Exposure to HIV-related communication on the media is associated with increased knowledge about HIV, which is in turn a strong predictor of accepting attitudes. Communication exposure also has a significant and positive association with accepting attitudes towards people living with HIV. In contrast, community media saturation is not strongly linked with accepting attitudes for either sex. The findings strongly suggest that media-based HIV programs constitute an effective strategy to combat HIV/AIDS-related stigma and should therefore be intensified in Nigeria.

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    • "A conventional observational approach would have generated the opposite finding: that additional schooling has a strong, statistically significant negative association with negative attitudes toward persons with HIV. Such conclusions have been reported previously (Babalola et al., 2009; Chiao et al., 2009; Girma et al., 2014; Stephenson, 2009). In contrast, our instrumental variables estimates have a causal interpretation and were not overturned by several robustness checks. "
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    ABSTRACT: HIV is highly stigmatized in sub-Saharan Africa. This is an important public health problem because HIV stigma has many adverse effects that threaten to undermine efforts to control the HIV epidemic. The implementation of a universal primary education policy in Uganda in 1997 provided us with a natural experiment to test the hypothesis that education is causally related to HIV stigma. For this analysis, we pooled publicly available, population-based data from the 2011 Uganda Demographic and Health Survey and the 2011 Uganda AIDS Indicator Survey. The primary outcomes of interest were negative attitudes toward persons with HIV, elicited using four questions about anticipated stigma and social distance. Standard least squares estimates suggested a statistically significant, negative association between years of schooling and HIV stigma (each P < 0.001, with t-statistics ranging from 4.9 to 14.7). We then used a natural experiment design, exploiting differences in birth cohort exposure to universal primary education as an instrumental variable. Participants who were <13 years old at the time of the policy change had 1.36 additional years of schooling compared to those who were ≥13 years old. Adjusting for linear age trends before and after the discontinuity, two-stage least squares estimates suggested no statistically significant causal effect of education on HIV stigma (P-values ranged from 0.21 to 0.69). Three of the four estimated regression coefficients were positive, and in all cases the lower confidence limits convincingly excluded the possibility of large negative effect sizes. These instrumental variables estimates have a causal interpretation and were not overturned by several robustness checks. We conclude that, for young adults in Uganda, additional years of education in the formal schooling system driven by a universal primary school intervention have not had a causal effect on reducing negative attitudes toward persons with HIV. Copyright © 2015 Elsevier Ltd. All rights reserved.
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