The impact of universal access to antiretroviral therapy on HIV stigma in Botswana
AMERICAN JOURNAL OF PUBLIC HEALTH
University of Botswana, University of California San Francisco, University of California System, University of Michigan, University of Michigan System, University of Minnesota System, University of Minnesota Twin Cities, Vet Affairs Ann Arbor Hlth Syst
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.