Volume 30, Number 2, June 2004
Stigma Against People Infected with HIV Poses A Major Barrier to Testing
Stigmatizing attitudes toward people with HIV/AIDS may play an important role in determining whether South African women and men get tested for HIV. According to data from 469 participants in a study on HIV testing behaviors,1 attitudes toward HIV testing are also linked to people's decisions to get tested and, once tested, to obtain their results.
To investigate the ways in which attitudes toward HIV testing and toward infected people are related to testing patterns, the researchers conducted surveys at 12 public locations in a primarily black township in Cape Town. Participants completed self-administered questionnaires that collected data on their demographic characteristics, HIV testing history and risk behaviors, and assessed their knowledge of HIV/AIDS prevention and treatment. The questionnaires also asked respondents whether they agreed or disagreed with a number of statements about how getting tested affects people's lives and about common negative attitudes toward people with HIV/AIDS.
Of the 276 women and 224 men surveyed, 98% were black, 67% were married, 52% had finished high school and 61% were unemployed; their median age range was 21-25 years. Forty-four percent of all respondents had been tested for HIV, 53% had never been tested and 3% refused to supply this information. Of those who had had an HIV test, 33% had been tested once, 29% twice and 19% three times; 53% reported that their most recent test had been negative, 9% positive and 38% did not know. Participants who refused to indicate whether they had been tested were excluded from the final sample, as were those who had tested positive. Analyses were based on data from the remaining 469 respondents, of whom 25% had tested negative, 18% did not know their results and 57% had never been tested.
HIV risk factors were generally high across testing groups: Overall, more than 40% had had two or more partners in the last three months, 17% had never used a condom, more than 10% had received food or money in exchange for sex, 34% had been diagnosed with a sexually transmitted infection (STI) and 13% had had a genital ulcer. Compared with those who had never been tested for HIV, a significantly lower proportion of respondents who had been tested reported that they had never used a condom (5-7% vs. 26%). However, all participants displayed high levels of knowledge about the prevention and treatment of HIV/AIDS (mean score, 83%), and scores did not differ significantly according to testing history.
Multiple logistic regressions that controlled for age, gender, education and survey venue indicated that participants who had been tested for HIV were significantly more likely than those who had never been tested to have a history of STI diagnosis (odds ratio, 1.7). They were also significantly less likely than those not tested to report that they had injected drugs or had never used a condom. In addition, participants who had been tested and obtained their results were significantly less likely than those who had been tested but did not know the outcome to report that they had either given or received compensation for sex (0.4 and 0.2, respectively).
The analyses also revealed significant associations between respondents' attitudes toward HIV testing and their testing status. Those who been tested for HIV were significantly more likely than those who had not been tested to agree with two statements asserting that HIV testing has a positive impact on people's lives (odds ratios, 2.2 and 2.9). Among respondents who had gotten an HIV test, those who had obtained their results had lower odds than those who had not of agreeing with three statements expressing negative views of testing (0.3-0.4). In addition, respondents who had had an HIV test were significantly less likely than those who had not been tested to endorse stigmatizing attitudes toward people with HIV/AIDS (0.3), and significantly more likely to support equal status for them (1.9). Knowing the results of one's test was not linked to the odds of holding stigmatizing attitudes.
The researchers acknowledge that their study is limited by being based on cross-sectional data from a nonrepresentative sample. They point out that although attitudes toward HIV testing may affect testing behaviors, most people who have not had an HIV test are aware of the benefits of testing. Therefore, they say, the social stigma attached to HIV/AIDS may be a more powerful deterrent to testing than attitudes toward testing itself. The researchers suggest that prevention and education programs seeking to improve testing patterns should continue to focus on reducing social stigma against people with HIV/AIDS. They conclude that "only through these efforts will AIDS stigma in South Africa be reduced and the goals of voluntary counseling and testing be realized."
1. Kalichman SC and Simbayi LC, HIV testing attitudes, AIDS stigma, and voluntary HIV counseling and testing in a black township in Cape Town, South Africa, Sexually Transmitted Infections, 2003, 79(6):442-447.