The Gendered Influence of Stigma on HIV Testing Behaviour: Results from a Population-Based Survey of Women and Men in Rwanda

Transcription

1 The Gendered Influence of Stigma on HIV Testing Behaviour: Results from a Population-Based Survey of Women and Men in Rwanda

2 Outline Background Context and Objective Methods Data collection Analysis Key Findings Discussion Conclusions

3 Background - Stigma Stigma has been defined as the co-occurrence of labeling, stereotyping, separation, status loss, and discrimination in a context in which power is exercised (Link & Phelan, 1999) HIV related stigma and discrimination take on multiple forms Has been linked to job loss, dismissal from school, violence, social exclusion, and denial of health services and support Can cause fear and isolation which might limit access to HIV testing, care, treatment May slow progress of global efforts to stop HIV Few studies have looked at impact of different forms of stigma on HIV testing behaviors Need to understand HIV testing behaviours, and how stigma might influence them, in order to develop targeted prevention efforts

4 Objective and Context Objective: To assess the impact of HIV-related stigma on testing behaviour among men and women in Rwanda ~200,000 people living with HIV (PLHIV) in Rwanda in 2014 Overall HIV prevalence of 2.8% among adults in general population (3.7% in women; 2.2% in men) High prevalence in Kigali (7.3%); prevalence in other provinces in below 3%

5 Methods - Survey Data collected from a pilot survey to update stigma questions included in Demographic and Health Survey (DHS) (n=4,669; 2,613 women and 2,056 men) Respondents had to be 15 years old to participate Data collected on sociodemographics, knowledge about HIV, and HIV-related stigma

6 Analysis Looked at basic sociodemographic indicators across the survey age gender education socioeconomic status marital status Explored associations with HIV testing "Have you ever been tested to see if you have the AIDS virus?

7 Analyses Assessment of HIV-related stigma: 1. I fear contracting HIV if come into contact with the saliva of a PLHIV 2. I would be ashamed if someone in my family had HIV 3. People talk badly about PLHIV 4. PLHIV lose respect and standing 5. People are hesitant to take an HIV test due to fear of people s reaction if test is positive 6. I would buy fresh vegetables from a shopkeeper who has the AIDS virus 7. A female teacher with the AIDS virus should be allowed to continue teaching 8. Children living with HIV should be allowed to attend school

8 Analysis Created composite variable for discriminatory attitudes I would buy fresh vegetables from a shopkeeper who has the AIDS virus A female teacher with the AIDS virus should be allowed to continue teaching Children living with HIV should be allowed to attend school Looked for associations between composite variable and all other independent stigma questions with testing behaviour in logistic regression models Basic HIV knowledge and knowing someone who has or is suspected to have the AIDS virus also included

9 Key Findings - participants Participants evenly sampled by gender (55% women, 45% men) 77.2% of participants reporting having ever tested for HIV Majority of participants had basic knowledge of HIV

10 Table 1. Testing behaviour and participant characteristics

11 Table. 2 Multivariable logistic regression of factors associated with HIV testing for Rwandan women a Unadjusted model; c Adjusted model including: sociodemographic, knowledge, proximity to the HIV epidemic and media exposure; and independent stigma variables, including composite discriminatory attitudes variable

12 Table. 3 Multivariable logistic regression of factors associated with HIV testing for Rwandan men a Unadjusted model; c Adjusted model including: sociodemographic, knowledge, proximity to the HIV epidemic and media exposure; and independent stigma variables, including composite discriminatory attitudes variable

13 Key messages Fear of contracting HIV, shame about a family member living with HIV, and holding two or more discriminatory attitudes associated with HIV testing behaviour among women Shame and two discriminatory attitude had association with testing among men Knowing someone living with HIV was a strongly associated with HIV testing in all models (men unadjusted OR 2.8; CI 2.1, 3.6 and women unadjusted OR 2.2; 95% CI 1.7, 2.8)

14 Discussion Findings suggest that stigma may influence HIV testing behaviour, and may do so differently among men and women Possible that pregnancy a major predictor for HIV testing among women did not have data on ever vs never pregnant and were unable to conduct separate analyses to investigate this

15 Conclusions May need tailored interventions, including stigma-reduction components, to increase HIV testing among both genders in Rwanda Targeted interventions may also be needed to increase testing among adolescents (aged 15-24) and older (50+) men and women Further analyses should be done to assess if and how HIV testing is associated with pregnancy and receiving antenatal care, and to assess how this association may be influenced by stigma

16 Acknowledgements Anne Stangl Kirsty Sievwright James Hargreaves References: Link BG, Pheln, JC. Conceptualizing stigma. Annual Review of Sociology. 2001; 27; Bharat, Shalini (2011) A systematic review of HIV/AIDS-related stigma and discrimination in India: Current understanding and future needs, SAHARA-J: Journal of Social Aspects of HIV/AIDS: An Open Access Journal, 8:3, References:Berendes, S., & Rimal, R. (2011). Addressing the Slow Uptake of HIV Testing in Malawi: The Role of Stigma, Self-efficacy, and Knowledge in the Malawi Bridge Project. Journal of the Association of Nurses in AIDS Care, Genberg, B. L. et al. (2009 ). A comparison of HIV/AIDS-related stigma in four countries: Negative attitudes. Social Science and Medicine, Rwanda Global AIDS Response Progress Report, 2014