The impact of universal access to antiretroviral therapy on HIV stigma in Botswana.
OBJECTIVE
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.
Wolfe
William R
WR
Physicians for Human Rights, Cambridge, MA, USA. william.wolfe@ucsf.edu
Weiser
Sheri D
SD
Leiter
Karen
K
Steward
Wayne T
WT
Percy-de Korte
Fiona
F
Phaladze
Nthabiseng
N
Iacopino
Vincent
V
Heisler
Michele
M
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001294:Attitude to Health; D001902:Botswana / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000458:organization & administration*; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009313:National Health Programs / Q000458:organization & administration; D015995:Prevalence; D015397:Program Evaluation; D012928:Social Desirability; D013240:Stereotyping; D011795:Surveys and Questionnaires; D019472:Universal Health Insurance / Q000458:organization & administration*
D019380:Anti-HIV Agents