title: HIV stigma trends in the general population during antiretroviral treatment expansion: analysis of 31 countries in sub-Saharan Africa, 2003-2013.
abstract: HIV-related stigma is associated with increased risk-taking behavior, reduced uptake of HIV testing, and decreased adherence to antiretroviral therapy (ART). Although ART scale-up may reduce HIV-related stigma, the extent to which levels of stigma in the general population have changed during the era of ART scale-up in sub-Saharan Africa is unknown.
  
  
  
  Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys and AIDS Indicator Surveys of 31 African countries between 2003 and 2013. We fitted multivariable linear regression models with cluster-correlated robust standard errors and country fixed effects, specifying social distance or anticipated stigma as the dependent variable and year as the primary explanatory variable of interest.
  
  
  
  We estimated a statistically significant negative association between year and desires for social distance (b = -0.020; P < 0.001; 95% confidence interval: -0.026 to -0.015) but a statistically significant positive association between year and anticipated stigma (b = 0.023; P < 0.001; 95% confidence interval: 0.018 to 0.027). In analyses stratified by HIV prevalence above or below the sample median, declines in social distancing over time were more pronounced among countries with a higher HIV prevalence.
  
  
  
  Concomitant with ART scale-up in sub-Saharan Africa, anticipated stigma in the general population increased despite a decrease in social distancing toward people living with HIV. Although ART scale-up may help reduce social distancing toward people living with HIV, particularly in high-prevalence countries, other interventions targeting symbolic or instrumental concerns about HIV may be needed.
authors.affiliation: *Division of Infectious Diseases, Brigham and Women's Hospital, Boston, MA; †Harvard Medical School, Boston, MA; ‡Center for Global Health and Department of Psychiatry, Massachusetts General Hospital, Boston, MA; and §Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Chan
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Tsai
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D012929:Psychological Distance; D012309:Risk-Taking; D057545:Social Stigma; D013240:Stereotyping; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents