Abstract:
What accounts for differences in HIV stigma across different high prevalence settings? This study was
designed to examine HIV stigma and discrimination in five high prevalence settings. Qualitative data
were collected as part of the U.S. National Institute of Mental Health (NIMH) Project Accept, a multi-site
community randomized trial of community-based HIV voluntary counseling and testing. In-depth
interviews were conducted with 655 participants in five sites, four in Sub-Saharan Africa and one in
Southeast Asia. Interviews were conducted in the local languages by trained research staff. Data were
audiotaped, transcribed, translated, coded and computerized for thematic data analysis. Participants
described the stigmatizing attitudes and behaviors perpetuated against people living with HIV/AIDS
(PLWHA). The factors that contribute to HIV stigma and discrimination include fear of transmission, fear
of suffering and death, and the burden of caring for PLWHA. The family, access to antiretrovirals and
other resources, and self-protective behaviors of PLWHA protected against HIV stigma and discrimination.
Variation in the availability of health and socioeconomic resources designed to mitigate the impact
of HIV/AIDS helps explain differences in HIV stigma and discrimination across the settings. Increasing
access to treatment and care resources may function to lower HIV stigma, however, providing services is
not enough.We need effective strategies to reduce HIV stigma as treatment and care resources are scaled
up in the settings that are most heavily impacted by the HIV epidemic.
