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AIDS Care. 2013;25(2):194-201. doi: 10.1080/09540121.2012.689810. Epub 2012 Jun 13.

Changing patterns in HIV/AIDS stigma and uptake of voluntary counselling and testing services: the results of two consecutive community surveys conducted in the Western Cape, South Africa.

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1
Department of Psychology, University of Stellenbosch, Cape Town, South Africa. sumaya.mall@gmail.com

Abstract

Voluntary counselling and HIV testing (VCT) has been associated with decreased human immunodeficiency virus (HIV) risk behaviour, but in South Africa, which has the largest HIV/acquired immune deficiency syndrome (AIDS) epidemic in the world, uptake of VCT remains low. HIV/AIDS-associated stigma has been identified as a barrier to HIV testing. This study explored changes in stigma, and VCT access in a peri-urban South African community with high HIV prevalence, following education and research interventions, as well as the introduction of a wide-scale antiretroviral therapy (ART) programme. Two cross-sectional community surveys assessing HIV knowledge, attitudes and uptake of VCT services were conducted. The first survey was performed in 2004 prior to the implementation of a community-based HIV awareness and education campaign, HIV prevention research studies and the introduction of an ART programme. The second survey was performed in 2008 after a three-year education programme, the implementation of HIV-related research studies and following the scale-up of the ART programme. The same study design was used in both the 2004 and 2008 surveys: 10% of households were randomly selected and all residents aged ≥ 14 years were invited to complete a self-administered questionnaire. Overall basic knowledge of HIV/AIDS increased from 2004 to 2008 (p=0.04) and stigmatisation towards HIV-positive individuals decreased over the same time period (p<0.001). Increasing knowledge score was significantly associated with a lower stigma score (p<0.001). Decreasing stigma score was associated with knowing someone who was HIV infected (p<0.001), or who had died from HIV/AIDS (p=0.04). The proportion of participants who had undergone HIV testing increased from 2004 to 2008 (40 vs. 70%, respectively) and, in particular, VCT increased from 26 to 43%. In adjusted analysis, participants who had undergone HIV testing were more likely to have a higher HIV knowledge score (p=0.02) and a lower stigma score (p=0.09). A reduction in levels of HIV/AIDS-associated stigma was noted in a community burdened with high HIV prevalence, as was an increase in reported VCT. These findings may be the result of a number of interventions including a wide-spread and targeted education campaign, and the "normalisation" of HIV through the availability of ART. Given the role of HIV/AIDS-associated stigma in influencing choices to access HIV testing, and the benefits associated with HIV testing, interventions to reduce stigma in communities affected by this disease should be encouraged.

PMID:
22694602
DOI:
10.1080/09540121.2012.689810
[Indexed for MEDLINE]
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