Stigma rises despite antiretroviral roll-out: A longitudinal analysis in South Africa

AIDS and Society Research Unit, University of Cape Town, Private Bag, Rondebosch, 7701, Cape Town, South Africa.
Social Science [?] Medicine (Impact Factor: 2.89). 11/2009; 70(3):368-74. DOI: 10.1016/j.socscimed.2009.09.041
Source: PubMed


Stigma is a recognised problem for effective prevention, treatment, and care of HIV/AIDS. However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS and (2) knowing people who died of AIDS. Panel survey data collected in Cape town 2003 and 2006 for 1074 young adults aged 14-22 years were used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS; instrumental stigma; and symbolic stigma. Individual fixed effects regression models are used to evaluate factors that influence stigma over time. Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased the most, followed by instrumental stigma, while negative behavioural intentions showed a modest increase. Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma and symbolic stigma, while increased personal contact with people living with HIV/AIDS was not significantly associated with any changes in stigma. Despite interventions, such as public-sector provision of antiretroviral treatment (which some hoped would have reduced stigma), stigma increased among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate the imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.

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    • "AIDSorphaned children experience high levels of internalizing problems, including depression, anxiety, and Post-traumatic Stress Syndrom (PTSD) symptoms, which persist over time (e.g., Bhargava, 2005; Cluver, Gardner, & Operario, 2007; Cluver, Orkin, Gardner, & Boyes, 2012; Nyamukapa et al., 2008). Furthermore, the poor mental health outcomes of this group appear to be further compounded by poverty, stigma, physical and emotional abuse, and bullying victimization (e.g., Boyes & Cluver, 2013; Cluver & Orkin, 2009; Cluver et al., 2013; Maughan-Brown, 2010). "
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    ABSTRACT: Research in high-income countries has identified an array of risk factors for youth antisocial behavior. However, in low- and middle-income countries, despite higher prevalence of offending and antisocial behavior, there is a paucity of prospective, longitudinal evidence examining predictors. South Africa is a middle-income country with high rates of violence and crime, and a unique social context, characterized by striking income and gender inequality, and increasing number of children orphaned by AIDS. We tested predictors of antisocial behavior at community, family, and individual levels over four years. One thousand and twenty five adolescents from poor, urban South African settlements were assessed in 2005 (50 percent female; M = 13.4 years) and followed up in 2009. The sample analyzed consisted of the 723 youth (71 percent) assessed at both time points. We employed sociodemographic questionnaires and standardized scales. Validity of our antisocial behavior measure was supported by cross-sectional associations with well-evidenced concomitants of youth antisocial behavior, including drug taking and truancy. Regression analysis indicated that male gender and experience of community violence, but not poverty or abuse, predicted antisocial behavior. Despite many South African youth experiencing abuse and poverty at the family level, our findings suggest that high levels of violence in communities may be a more important factor contributing to the development of antisocial behavior, particularly among males.
    Review of Social Development 06/2015; 24(4). DOI:10.1111/sode.12127 · 1.56 Impact Factor
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    • "Our stigma scales would be valid if greater HIV transmission knowledge correlated with lower endorsement of stigma. Additional validity was gaged via resemblance with dimensions associated with the labeling theory of stigma (Mahajan et al., 2008) and reported in relatable settings (Feyissa, Abebe, Girma, & Woldie, 2012; Holzemer et al., 2007; Maughan-Brown, 2010; Nyblade, 2006). "
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    ABSTRACT: In the age of antiretroviral therapy (ART), unraveling specific aspects of stigma that impede uptake and adherence to human immunodeficiency virus (HIV) services and the complex intersections among them might enhance the efficacy of stigma-reduction interventions targeted at the general public. Few studies have described community stigma in high HIV prevalence regions of Mozambique where program scale-up has been concentrated, but fear of stigma persists as a barrier to HIV service uptake. Principal components analysis of attitudinal data from 3749 female heads of households surveyed in Zambézia Province was used to examine patterns of agreement with stigmatizing attitudes and behavior toward people living with HIV. Inferences were based on comparison of factor loadings and commonality estimates. Construct validity was established through correlations with levels of knowledge about HIV transmission and consistency with the labeling theory of stigma. Two unique domains of community stigma were observed: negative labeling and devaluation (NLD, α = 0.74) and social exclusion (SoE, α = 0.73). NLD is primarily an attitudinal construct, while SoE captures behavioral intent. About one-third of the respondents scored in the upper tertile of the NLD stigma scale (scale: 0-100 stigma points) and the equivalent was 41.3% in the SoE stigma scale. Consistent with literature, NLD and SoE stigma scores were inversely correlated with HIV transmission route knowledge. In item level analysis, fear of being labeled a prostitute/immoral and of negative family affect defined the nature of stigma in this sample. Thus, despite ART scale-up and community education about HIV/acquired immune deficiency syndrome (AIDS), NLD and SoE characterized the community stigma of HIV in this setting. Follow-up studies could compare the impact of these stigma domains on HIV services uptake, in order to inform domain-focused stigma-reduction interventions.
    AIDS Care 11/2013; 26(7). DOI:10.1080/09540121.2013.861570 · 1.60 Impact Factor
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    • "Stigma, anxiety, and depression in HIV/AIDS-orphaned youth 3 HIV/AIDS has resulted in a substantial increase in the number of orphans internationally and UNICEF estimate that by 2020 40 million youths may have lost one or both parents to HIV/AIDS (Maughan Brown, 2010). Sub-Saharan Africa has been most severely affected and accounts for over 80% of HIV/AIDS-orphaned youth. "
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    ABSTRACT: Cross-sectional research has demonstrated that HIV/AIDS orphanhood is associated with anxiety and depression and that HIV/AIDS-related stigma is a risk factor for these outcomes. This study used a longitudinal data set to determine whether relationships between HIV/AIDS orphanhood and anxiety/depression scores (measured at 4-year follow-up) operate indirectly via perceived stigma. Youths from poor communities around Cape Town were interviewed in 2005 (n = 1,025) and followed up in 2009 (n = 723). At baseline, HIV/AIDS-orphaned youth reported significantly higher stigma and depression scores than youth not orphaned by HIV/AIDS. At follow-up, HIV/AIDS-orphaned youth reported significantly higher stigma, anxiety, and depression scores. However, HIV/AIDS orphanhood was not directly associated with anxiety or depression. Instead, significant indirect effects (operating through perceived stigma) were obtained for both assessment periods. Results demonstrate that stigma persists across time and appears to mediate relationships between HIV/AIDS orphanhood and psychological distress. Interventions aiming to reduce stigma may help promote the mental health of HIV/AIDS-orphaned youth.
    07/2013; 1(3):323-330. DOI:10.1177/2167702613478595
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