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The impact of universal access to antiretroviral therapy on HIV stigma in Botswana

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  • Wolfe, W.R.
  • Weiser, S.D.
  • Leiter, K.
  • Steward, W.T.
  • Percy-de Korte, F.
  • Phaladze, N.
  • Iacopino, V.
  • Heisler, M.

Abstract

Objectives. We sought to examine the impact of treatment access on HIV stigma in Botswana 3 years after the introduction of a national program of universal access to antiretroviral therapy. Methods. We studied the prevalence and correlates of HIV stigma in a population-based study of 1268 adults in Botswana in 2004. We used multivariate logistic regression to assess correlates of stigmatizing attitudes and a new measure, anticipated HIV stigma. Results. Overall, 38% of participants had at least 1 stigmatizing attitude: 23% would not buy food from a shopkeeper with HIV; 5% would not care for a relative with HIV. Seventy percent reported at least 1 measure of anticipated stigma: 54% anticipated ostracism after testing positive for HIV, and 31% anticipated mistreatment at work. Perceived access to antiretroviral therapy was strongly and independently associated with decreased odds of holding stigmatizing attitudes (adjusted odds ratio [AOR] = 0.42; 95% confidence interval [CI] = 0.24, 0.74) and of anticipated stigma (AOR = 0.09; 95% CI = 0.03, 0.30). Conclusions. Our findings suggest that antiretroviral therapy access may be a factor in reducing HIV stigma. Nevertheless, the persistence of stigmatizing attitudes and significant anticipated stigma suggest that HIV stigma must be a target for ongoing intervention.

Suggested Citation

  • Wolfe, W.R. & Weiser, S.D. & Leiter, K. & Steward, W.T. & Percy-de Korte, F. & Phaladze, N. & Iacopino, V. & Heisler, M., 2008. "The impact of universal access to antiretroviral therapy on HIV stigma in Botswana," American Journal of Public Health, American Public Health Association, vol. 98(10), pages 1865-1871.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2007.122044_3
    DOI: 10.2105/AJPH.2007.122044
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    1. Jürgensen, Marte & Sandøy, Ingvild Fossgard & Michelo, Charles & Fylkesnes, Knut, 2013. "Effects of home-based Voluntary Counselling and Testing on HIV-related stigma: Findings from a cluster-randomized trial in Zambia," Social Science & Medicine, Elsevier, vol. 81(C), pages 18-25.
    2. Tsai, Alexander C. & Venkataramani, Atheendar S., 2015. "The causal effect of education on HIV stigma in Uganda: Evidence from a natural experiment," Social Science & Medicine, Elsevier, vol. 142(C), pages 37-46.
    3. Maman, Suzanne & Abler, Laurie & Parker, Lisa & Lane, Tim & Chirowodza, Admire & Ntogwisangu, Jacob & Srirak, Namtip & Modiba, Precious & Murima, Oliver & Fritz, Katherine, 2009. "A comparison of HIV stigma and discrimination in five international sites: The influence of care and treatment resources in high prevalence settings," Social Science & Medicine, Elsevier, vol. 68(12), pages 2271-2278, June.
    4. McGinty, Emma E. & Goldman, Howard H. & Pescosolido, Bernice & Barry, Colleen L., 2015. "Portraying mental illness and drug addiction as treatable health conditions: Effects of a randomized experiment on stigma and discrimination," Social Science & Medicine, Elsevier, vol. 126(C), pages 73-85.
    5. Feigl, Andrea B. & Ding, Eric L., 2013. "Evidenced Formal Coverage Index and universal healthcare enactment: A prospective longitudinal study of economic, social, and political predictors of 194 countries," Health Policy, Elsevier, vol. 113(1), pages 50-60.
    6. Arimoto, Yutaka & Hori, Narumi & Ito, Seiro & Kudo, Yuya & Tsukada, Kazunari, 2012. "Impacts of an HIV Counselling and Testing Initiative: Results from an Experimental Intervention in South Africa," CEI Working Paper Series 2011-13, Center for Economic Institutions, Institute of Economic Research, Hitotsubashi University.
    7. Genberg, Becky L. & Hlavka, Zdenek & Konda, Kelika A. & Maman, Suzanne & Chariyalertsak, Suwat & Chingono, Alfred & Mbwambo, Jessie & Modiba, Precious & Van Rooyen, Heidi & Celentano, David D., 2009. "A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS," Social Science & Medicine, Elsevier, vol. 68(12), pages 2279-2287, June.
    8. Gausset, Quentin & Mogensen, Hanne Overgaard & Yameogo, Wambi Maurice Evariste & Berthé, Abdramane & Konaté, Blahima, 2012. "The ambivalence of stigma and the double-edged sword of HIV/AIDS intervention in Burkina Faso," Social Science & Medicine, Elsevier, vol. 74(7), pages 1037-1044.
    9. Tsai, Alexander C. & Bangsberg, David R. & Emenyonu, Nneka & Senkungu, Jude K. & Martin, Jeffrey N. & Weiser, Sheri D., 2011. "The social context of food insecurity among persons living with HIV/AIDS in rural Uganda," Social Science & Medicine, Elsevier, vol. 73(12), pages 1717-1724.
    10. Cook, Jonathan E. & Purdie-Vaughns, Valerie & Meyer, Ilan H. & Busch, Justin T.A., 2014. "Intervening within and across levels: A multilevel approach to stigma and public health," Social Science & Medicine, Elsevier, vol. 103(C), pages 101-109.
    11. Arimoto, Yutaka & Hori, Narumi & Ito, Seiro & Kudo, Yuya & Tsukada, Kazunari, 2016. "Impacts of an HIV counseling and testing initiative -- results from an experimental intervention in a large firm in South Africa," IDE Discussion Papers 597, Institute of Developing Economies, Japan External Trade Organization(JETRO).

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