title: Community stigma endorsement and voluntary counseling and testing behavior and attitudes among female heads of household in Zambézia Province, Mozambique.
abstract: BACKGROUND
  Some aspects of HIV-related stigma have been shown to be a barrier to HIV services uptake and adherence to antiretroviral treatment (ART). Distinguishing which domains of stigma impact HIV services uptake can enhance the efficacy and efficiency of stigma-reduction interventions.
  
  
  METHODS
  The relationships between use of voluntary counseling and testing (VCT) services and two domains of community stigma identified through factor analysis, negative labeling/devaluation and social exclusion, were investigated among 3749 female heads of household. Data were from a general household survey conducted in rural Mozambique. Multivariable logistic regression outcomes were: lifetime VCT use, past-6-months VCT use and VCT endorsement.
  
  
  RESULTS
  Thirteen percent (13%) of the participants reported lifetime VCT use, 10% reported past-6-months VCT use and 63% endorsed VCT. A 25-point decrease (from 50 to 25) in the score for negative labeling and devaluation stigma was associated with increased lifetime VCT use (adjusted OR: 1.6, 95% CI: 1.1-2.3) and past-6-months VCT use (adjusted OR: 1.6, 95% CI: 1.1-2.4). A decrease from 50 to 25-points in the score for social exclusion stigma was associated with 1.5 and 1.3-fold increase in odds for past-6-months VCT use and endorsing VCT use, respectively (p < 0.001 for both). Compared with never-testers, considerably high endorsement of VCT use was observed among testers who did not receive HIV test results (adjusted OR: 2.7, 95% CI: 1.6-4.6) and much higher among testers who received results (adjusted OR: 7.3, 95% CI: 4.9-11.0). Distance from health facilities was associated with lower VCT use, but not lower endorsement of VCT.
  
  
  CONCLUSIONS
  VCT use and endorsement might differ by domains of stigma held by individuals in the community. Greater uptake and favorable disposition towards use of VCT services in rural settings might be achieved by addressing stigma via domain-specific interventions and by improving the proximity of services and the dissemination of HIV test results.
authors: Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, USA. abraham.mukolo@vanderbilt.edu.
authors: Abraham
authors: A
authors: Mukolo
authors: Meridith
authors: M
authors: Blevins
authors: Bart
authors: B
authors: Victor
authors: Heather N
authors: HN
authors: Paulin
authors: Lara M E
authors: LM
authors: Vaz
authors: Mohsin
authors: M
authors: Sidat
authors: Alfredo E
authors: AE
authors: Vergara
mesh_terms: D000328:Adult; D003376:Counseling / Q000706:statistics & numerical data*; D005191:Family Characteristics; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology*; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008403:Mass Screening / Q000706:statistics & numerical data*; D009073:Mozambique; D019035:Rural Health Services / Q000706:statistics & numerical data; D057545:Social Stigma; D035141:Voluntary Programs / Q000706:statistics & numerical data*; D055815:Young Adult