Background: Stigma is a recognised problem for effective prevention, treatment and care of HIV/AIDS. However, few studies have measured changes in the magnitude and character of stigma over time. This paper provides the first quantitative evaluation in Africa of the changing nature of stigma and the potential determinants of these changes. More specifically, it evaluates the dynamic relationship between stigma and (1) increased personal contact with people living with HIV/AIDS (i.e., the contact hypothesis) and (2) knowing people who died of AIDS.
Methods: Panel survey data collected in 2003 and 2006 for 1074 young adults (54% women, 46% men) is used to evaluate changes in three distinct dimensions of stigma: behavioural intentions towards people living with HIV/AIDS, instrumental stigma (inflated fear of infection) and symbolic stigma (expressions of negative moral judgement). Individual fixed effects regression models are used to evaluate factors that influence stigma over time.
Results: Each dimension of stigma increased in the population as a whole, and for all racial and gender sub-groups. Symbolic stigma increased most significantly, followed by instrumental stigma, while negative behavioural intentions showed a modest increase. Knowing someone who died of AIDS was significantly associated with an increase in instrumental stigma (p < 0.01) and symbolic stigma (p < 0.001). Increased personal contact with people living with HIV/AIDS was not significantly associated with changes in stigma. Importantly, increases in instrumental stigma (p < 0.001) predicted increases in negative behavioural intentions.
Conclusion: Stigma increased despite interventions, such as public sector provision of HAART (which some hoped would have reduced stigma), and among a sample highly targeted with HIV-prevention messages. These findings emphasise that changes in stigma are difficult to predict and thus important to monitor. They also indicate an imperative for renewed efforts to reduce stigma, perhaps through interventions to weaken the association between HIV/AIDS and death, to reduce fear of HIV/AIDS, and to recast HIV as a chronic manageable disease.
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