title: Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less-wealthy countries.
abstract: BACKGROUND
  In the face of the HIV/AIDS epidemic that has contributed to the dramatic increase in orphans and abandoned children (OAC) worldwide, caregiver attitudes about HIV, and HIV-related stigma, are two attributes that may affect caregiving. Little research has considered the relationship between caregiver attributes and caregiver-reported HIV-related stigma. In light of the paucity of this literature, this paper will describe HIV-related stigma among caregivers of OAC in five less wealthy nations.
  
  
  METHODS
  Baseline data were collected between May 2006 through February 2008. The sample included 1,480 community-based and 192 institution-based caregivers. Characteristics of the community-based and institution-based caregivers are described using means and standard deviations for continuous variables or counts and percentages for categorical variables. We fit logistic regression models, both for the full sample and separately for community-based and institution-based caregivers, to explore predictors of acceptance of HIV.
  
  
  RESULTS
  Approximately 80% of both community-based and institution-based caregivers were female; and 84% of institution-based caregivers, compared to 66% of community-based caregivers, said that they would be willing to care for a relative with HIV. Similar proportions were reported when caregivers were asked if they were willing to let their child play with an HIV-infected child. In a multivariable model predicting willingness to care for an HIV-infected relative, adjusted for site fixed effects, being an institution-based caregiver was associated with greater willingness (less stigma) than community-based caregivers. Decreased willingness was reported by older respondents, while willingness increased with greater formal education. In the adjusted models predicting willingness to allow one's child to play with an HIV-infected child, female gender and older age was associated with less willingness. However, willingness was positively associated with years of formal education.
  
  
  CONCLUSIONS
  The caregiver-child relationship is central to a child's development. OAC already face stigma as a result of their orphaned or abandoned status; the addition of HIV-related stigma represents a double burden for these children. Further research on the prevalence of HIV-related acceptance and stigma among caregivers and implications of such stigma for child development will be critical as the policy community responds to the global HIV/AIDS orphan crisis.
authors: Center for Health Policy and Inequalities Research, 2812 Erwin Rd, Suite 403, Duke University Campus Box 90392, Durham, NC 27705, USA. lynne.messer@duke.edu
authors: Lynne C
authors: LC
authors: Messer
authors: Brian W
authors: BW
authors: Pence
authors: Kathryn
authors: K
authors: Whetten
authors: Rachel
authors: R
authors: Whetten
authors: Nathan
authors: N
authors: Thielman
authors: Karen
authors: K
authors: O'Donnell
authors: Jan
authors: J
authors: Ostermann
mesh_terms: D000293:Adolescent; D000328:Adult; D017028:Caregivers / Q000523:psychology*; D054540:Child, Orphaned; D003625:Data Collection; D003906:Developing Countries; D005260:Female; D015658:HIV Infections; D006282:Health Personnel / Q000523:psychology*; D006801:Humans; D008875:Middle Aged; D011287:Prejudice; D055815:Young Adult