title: Stigma against People Living with HIV/AIDS in China: Does the Route of Infection Matter?
abstract: In the current study, we tested the hypothesis that people who contracted HIV from "blameless" routes (e.g., blood transfusion, sex with stable partners) are less stigmatized compared to people who contracted HIV from "blamable" routes (e.g., injection drug use, sex with sex workers). A cross-sectional study was conducted among 2,987 participants in Guangxi province, China, between 2012 and 2013. We employed both explanatory and predictive modeling strategy by using multivariate linear regression models. In the explanatory models, we assessed the association between routes of infection and three types of stigma (perceived, internalized, and enacted). From identified routes of infection that significantly contributed to higher stigma, we employed predictive modeling to explore predictors for the specific type of stigma. Multiple-imputation was employed for sensitivity analyses. Of the total sample, 63% were male and the average age was 42.9 years (ranged between 18 and 88). Multivariate regression models revealed that contraction from commercial sex increased the perceived (β = 0.46, 95%CI = 0.02, 0.90) and internalized stigma (β = 0.60, 95%CI = 0.09, 1.10), while injecting drug use increased the perceived (β = 0.65, 95%CI = 0.07, 1.22) and enacted stigma (β = 0.09, 95%CI = 0.02, 0.16) after controlling for confounders. Among PLWHA who were infected via commercial sex partners, social support was negatively associated with perceived (β = -0.47, 95%CI = -0.79, -0.14) and internalized stigma (β = -0.80, 95%CI = -1.24, -0.35). Among PLWHA who were infected via injecting drugs, no adherence to antiretroviral treatment (β = 0.41, 95%CI = 0.01, 0.82) was positively associated with perceived stigma, and disclosure of serostatus to others was negatively associated with enacted stigma (β = -0.20, 95%CI = -0.34, -0.05). Knowledge of the association between routes of infection and stigma can guide health professionals and policy makers to develop tailored intervention strategies to mitigate the effects of stigma and enhance HIV care utilization among PLWHA in China.
authors.affiliation: Divison of Epidemiology, Vanderbilt University, Nashville, Tennessee, United State of America.
authors.forename: Chen
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United State of America.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Li
authors.affiliation: Divison of Epidemiology, Vanderbilt University, Nashville, Tennessee, United State of America.
authors.forename: Yu
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, United State of America.
authors.forename: Shan
authors.initials: S
authors.lastname: Qiao
authors.affiliation: Department of Pediatrics, Wayne State University, Detroit, Michigan, United State of America.
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China.
authors.forename: Yuejiao
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China.
authors.forename: Zhenzhu
authors.initials: Z
authors.lastname: Tang
authors.affiliation: Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Shen
authors.affiliation: Department of HIV/STD Prevention, Guangxi CDC, Nanning, Guangxi, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011477:Sex Work; D012747:Sexual Partners; D057545:Social Stigma; D012944:Social Support; D013240:Stereotyping; D055815:Young Adult