P43.11
Background: Uganda is the only country in sub-Saharan Africa with increasing HIV incidence during the period 2002–2013. Because HIV-related stigma is associated with reduced uptake of HIV testing, increased risk-taking behavior, decreased adherence to anti-retroviral therapy (ART), and reduced HIV status disclosure, it is critical to understand how changes in HIV incidence have correlated with HIV-related stigma during this period.
Methods: We analyzed data from two sources:
1) the Uganda AIDS Rural Treatment Outcomes (UARTO) study during 2007–2012 and
2) the Uganda Demographic and Health Surveys (DHS) from 2006 and 2011 to estimate trends in internalized stigma among people living with HIV (PLHIV) at ART initiation and trends in stigmatizing attitudes and anticipated stigma among the general population. We fit regression models adjusted for socio-demographic characteristics, with year of cohort entry/DHS as the primary explanatory variable.
Results: Among people initiating ART in the UARTO study, we found a statistically significant positive association between year of ART initiation and internalized stigma score (adjusted b=0.17; 95% CI, 0.05 to 0.29), suggesting an 11% relative increase in the mean score in each year of recruitment after the first year. From 1.4 (out of 4) at baseline, the mean stigma score increased to a peak of 2.2 in 2011. Among the general population comparing 2011 with 2006 DHS data, we found a significantly higher odds of reporting anticipated stigma (adjusted OR=1.12; 95% CI, 1.08 to 1.17), despite a decreased odds of reporting stigmatizing attitudes (adjusted OR=0.90; 95% CI, 0.87 to 0.93).
Conclusions: Mean internalized stigma at ART initiation increased over time among PLHIV in a rural Ugandan cohort in the setting of worsening anticipated stigma among the general population. Further study is needed to better understand the reasons for increasing HIV-related stigma and its impact on HIV prevention efforts in Uganda.
