Individuals with stigmatising beliefs about HIV are less likely to test for the virus, an international team of investigators report in the online edition of the Journal of Acquired Immune Deficiency Syndromes. The research involved 5249 individuals in the South African townships of Soweto and Vulindlela. Only 41% had ever tested for HIV.
“Compared to those who had never tested, people who tested were significantly less likely to hold negative attitudes and beliefs about people living with HIV, more likely to believe people with HIV face discrimination, more likely to hold beliefs that people living with HIV should be treated equally, and more likely to believe that most people have previously tested for HIV,” write the investigators.
Stigma must be addressed in future studies looking at improving HIV testing rates in South Africa, the authors stress.
Many patients with HIV die needlessly because their HIV is diagnosed late. There is also good evidence that many new HIV transmissions originate in undiagnosed individuals. Therefore increasing rates of HIV testing is a public health priority, especially in South Africa, where there is a high prevalence of undiagnosed infections.
Investigators from Project Accept wanted to examine the associations between HIV testing and perceptions of stigma and social norms in South Africa.
A total of 5259 individuals aged between 18 and 32 were therefore asked to complete a questionnaire. This enquired about the individuals’ HIV testing history.
Questions were also included on HIV-related stigma. These were designed to see if the participants had negative attitudes towards people with HIV. For example, they were asked to agree or disagree with statements such as “people who have HIV/AIDS are cursed”, and “people with AIDS are disgusting”.
Participants were also asked if they thought people with HIV were discriminated against, and if they believed people with HIV should be treated equally.
Finally, a question was included to see if testing for HIV was perceived to be the social norm, and participants were also asked to indicate if they believed “most people have been tested for HIV”.
Overall, 41% of individuals reported that they had had an HIV test. These individuals were older (25 vs 22) and better educated than those who had never tested (13+ years of education: 11 vs 7%).
The investigators’ first set of analyses showed that the following factors were associated with an increased likelihood of testing:
More years of education (p = 0.04)
Less stigmatising beliefs about people with HIV (p = 0.0028)
A greater belief that people with HIV faced discrimination (p = 0.0086)
A belief that people with HIV should be treated equally (p = 0.0086)
A belief that most people have had an HIV test (p = 0.0115).
Further analysis showed that women (p = 0.0078), older individuals (p = 0.0141), and those with 13 or more years of education (p = 0.0016) were significantly more likely to have tested.
However, the relationship between two of these measures (sex and education), and an increased likelihood of testing, weakened with age.
In contrast, the relationship between testing and a belief that people with HIV experienced discrimination increased with age (p = 0.001). Women who believed that people with HIV should be treated equally were more likely to have tested than men who had this belief (p = 0.009).
‘The present study suggests a link between HIV testing, stigma, and social norms such that decreasing HIV-related stigma may help to increase testing,” comment the investigators.
They continue, “interventions that culturally and demographically tailored toward populations of interest might prove to be more effective in decreasing stigma and increasing testing.”
Use of self-reported testing history, and gathering information on stigma via a questionnaire was, the investigators acknowledge, a potential limitation of their study. They comment, “it is possible that participants were motivated to underreport negative attitudes related to HIV because of social desirability."
However, the researchers are confident that their study “builds on results of previous research on stigma and testing and suggests that stigma is associated with people’s HIV testing behaviour”.
They conclude that it is “imperative” that future studies looking at ways of increasing HIV testing in South Africa address stigma.
Young SD et al. HIV related stigma, social norms, and HIV Testing in Soweto and Vuildlela, South Africa: National Institutes of Mental Health Project Accept (HPTN 043). J Acquir Immune Defic Syndr, online edition, 2010 (click here for the study’s abstract).