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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

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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.

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Acknowledgements

We would like to thank the research participants for their time and willingness to share information about their lives. We are deeply appreciative of the study staff, the community liaison office (LINC) staff, and data collection team whose hard work made this research possible, especially Amanda Selin, Rushina Cholera and Sheree Schwartz. We also thank Eric Vittinghoff for his assistance with programming the statistical analysis.

Funding

This work was supported by the United States National Institute of Mental Health under Grant 1R01MH087118-01 (Pettifor) and Grant 1R21MH090887-01 (Lippman). The Agincourt HDSS is supported by the Wellcome Trust, UK under Grants 058893/Z/99/A; 069683/Z/02/Z; 085477/Z/08/Z; 085477/B/08/Z; the South African Medical Research Council; and the University of Witwatersrand.

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Authors and Affiliations

  1. Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA

    Sarah Treves-Kagan & Sheri A. Lippman

  2. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Sarah Treves-Kagan, Audrey Pettifor & Suzanne Maman

  3. Department of Obstetrics, Gynecology and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, San Francisco, CA, USA

    Alison M. El Ayadi

  4. Wits Reproductive Health and HIV Institute (WRHI), Faculty of Health Sciences, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa

    Audrey Pettifor & Catherine MacPhail

  5. 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

    Audrey Pettifor, Catherine MacPhail, Rhian Twine, Kathleen Kahn & Sheri A. Lippman

  6. School of Health, University of New England, Armidale, Australia

    Catherine MacPhail

  7. Sonke Gender Justice, Cape Town, South Africa

    Dean Peacock

  8. Umeå Centre for Global Health Research, Division of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 90187, Umeå, Sweden

    Kathleen Kahn

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  1. Sarah Treves-Kagan
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Correspondence to Sarah Treves-Kagan.

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Conflict of interest

Sarah Treves-Kagan, Alison M. El Ayadi, Audrey Pettifor, Catherine MacPhail, Suzanne Maman, Dean Peacock, Kathleen Kahn, and Sheri A. Lippman declare that they have no conflict of interest.

Ethical approval

Research procedures were approved by the Institutional Review Boards at the University of North Carolina-Chapel Hill and the University of California, San Francisco, and the Human Research Ethics Committee at the University of the Witwatersrand in South Africa. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Treves-Kagan, S., El Ayadi, A.M., Pettifor, A. et al. 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. AIDS Behav 21, 2579–2588 (2017). https://doi.org/10.1007/s10461-016-1671-8

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