Prevalence and associated factors of enacted, internalized and anticipated stigma among people living with HIV in South Africa: Results of the first national survey

Abstract

Background: This paper reports on the first national implementation of the “People Living with HIV (PLHIV) Stigma Index” in South Africa. The aim of this study was to investigate the prevalence and correlates of HIV-related stigma in a large sample of PLHIV in South Africa. Methods: This cross-sectional survey interviewed 10,473 PLHIV 15 years and older with the PLHIV Stigma Index in two districts per province (N=9) in South Africa in 2014. Results: The two most common enacted HIV-related stigma items were “being gossiped about” (20.6%) and “experienced discrimination” (15.1%); internalized stigma was ”blaming oneself” (30.5%) and ashamed (28.7%); avoidance due to internalized stigma was “decided not to have (more) children” (32.4%) and “decided not to get married” (14.9%), and the two most endorsed anticipated stigma were “being gossiped about” (28.6%) and not want to be sexually intimate (21.1%) Various sociodemographic factors, such as younger age, being female, lesbian, gay, bisexual and transgender (LGBT) and lower wealth status, and health-related variables, such as poorer self-rated health status, having a physical disability, and not being a member of an HIV support group, were identified as associated with overall HIV-related stigma as well as several HIV-related stigma sub-scales. Conclusion: The majority of PLHIV had overall HIV-related stigma, almost half had internalized, or anticipated HIV-related stigma and a minority had enacted HIV-related stigma. Findings can be used to guide intervention programs to reduce HIV-related stigma in South Africa.