title: Community patterns of stigma towards persons living with HIV: a population-based latent class analysis from rural Vietnam.
abstract: BACKGROUND
  The negative effects of stigma on persons living with HIV (PLHIV) have been documented in many settings and it is thought that stigma against PLHIV leads to more difficulties for those who need to access HIV testing, treatment and care, as well as to limited community uptake of HIV prevention and testing messages. In order to understand and prevent stigma towards PLHIV, it is important to be able to measure stigma within communities and to understand which factors are associated with higher stigma.
  
  
  METHODS
  To analyze patterns of community stigma and determinants to stigma toward PLHIV, we performed an exploratory population-based survey with 1874 randomly sampled adults within a demographic surveillance site (DSS) in rural Vietnam. Participants were interviewed regarding knowledge of HIV and attitudes towards persons living with HIV. Data were linked to socioeconomic and migration data from the DSS and latent class analysis and multinomial logistic regression were conducted to examine stigma group sub-types and factors associated with stigma group membership.
  
  
  RESULTS
  We found unexpectedly high and complex patterns of stigma against PLHIV in this rural setting. Women had the greatest odds of belong to the highest stigma group (OR 1.84, 95% CI 1.42-2.37), while those with more education had lower odds of highest stigma group membership (OR 0.45, 95% CI 0.32-0.62 for secondary education; OR 0.19, 95% CI 0.10-0.35 for tertiary education). Long-term migration out of the district (OR 0.61, 95% CI 0.4-0.91), feeling at-risk for HIV (OR 0.42, 95% CI 0.27-0.66), having heard of HIV from more sources (OR 0.44, 95% CI 0.3-0.66), and knowing someone with HIV (OR 0.76, 95% CI 0.58-0.99) were all associated with lower odds of highest stigma group membership. Nearly 20% of the population was highly unsure of their attitudes towards PLHIV and persons in this group had significantly lower odds of feeling at-risk for HIV (OR 0.54, 95% CI 0.33-0.90) or of knowing someone with HIV (OR 0.32, 95% CI 0.22-0.46).
  
  
  CONCLUSIONS
  Stigma towards PLHIV is high generally, and very high in some sub-groups, in this community setting. Future stigma prevention efforts could be enhanced by analyzing community stigma sub-groups and tailoring intervention messages to community patterns of stigma.
authors.affiliation: Division of Global Health/IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. anastasia.pharris@ki.se
authors.forename: Anastasia
authors.initials: A
authors.lastname: Pharris
authors.forename: Nguyen Phuong
authors.initials: NP
authors.lastname: Hoa
authors.forename: Carol
authors.initials: C
authors.lastname: Tishelman
authors.forename: Gaetano
authors.initials: G
authors.lastname: Marrone
authors.forename: Nguyen Thi
authors.initials: NT
authors.lastname: Kim Chuc
authors.forename: Ruairí
authors.initials: R
authors.lastname: Brugha
authors.forename: Anna
authors.initials: A
authors.lastname: Thorson
mesh_terms: D000293:Adolescent; D000328:Adult; D003625:Data Collection; D005260:Female; D020276:HIV Long-Term Survivors; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D011287:Prejudice; D012044:Regression Analysis; D012424:Rural Population; D014744:Vietnam; D055815:Young Adult