title: Gender, HIV Testing and Stigma: The Association of HIV Testing Behaviors and Community-Level and Individual-Level Stigma in Rural South Africa Differ for Men and Women.
abstract: Stigma remains a significant barrier to HIV testing in South Africa. Despite being a social construct, most HIV-stigma research focuses on individuals; further the intersection of gender, testing and stigma is yet to be fully explored. We examined the relationship between anticipated stigma at individual and community levels and recent testing using a population-based sample (n = 1126) in Mpumalanga, South Africa. We used multi-level regression to estimate the potential effect of reducing community-level stigma on testing uptake using the g-computation algorithm. Men tested less frequently (OR 0.22, 95% CI 0.14-0.33) and reported more anticipated stigma (OR 5.1, 95% CI 2.6-10.1) than women. For men only, testing was higher among those reporting no stigma versus some (OR 1.40, 95% CI 0.97-2.03; p = 0.07). For women only, each percentage point reduction in community-level stigma, the likelihood of testing increased by 3% (p < 0.01). Programming should consider stigma reduction in the context of social norms and gender to tailor activities appropriately.
authors.affiliation: Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA. kagan.sarah@gmail.com.|Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. kagan.sarah@gmail.com.
authors.forename: Sarah
authors.identifier: http://orcid.org/0000-0003-0369-6288
authors.initials: S
authors.lastname: Treves-Kagan
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Alison M
authors.initials: AM
authors.lastname: El Ayadi
authors.affiliation: Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.|MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Audrey
authors.initials: A
authors.lastname: Pettifor
authors.affiliation: Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa.|MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|School of Health, University of New England, Armidale, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: MacPhail
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Rhian
authors.initials: R
authors.lastname: Twine
authors.affiliation: Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Maman
authors.affiliation: Sonke Gender Justice, Cape Town, South Africa.
authors.forename: Dean
authors.initials: D
authors.lastname: Peacock
authors.affiliation: MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.|Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Umeå, Sweden.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Kahn
authors.affiliation: Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA.|MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Sheri A
authors.initials: SA
authors.lastname: Lippman
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000328:Adult; D001294:Attitude to Health; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008403:Mass Screening / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D010465:Perception; D012424:Rural Population; D012737:Sex Factors; D057545:Social Stigma; D013019:South Africa
keywords: Community; Gender; HIV; Rural; South Africa; Stigma