HIV stigma: half of people in 15 African national surveys hold discriminatory attitudes

National health surveys from 15 sub-Saharan African countries suggests 47% of people have discriminatory attitudes towards people with HIV. And younger people and those with low income or education levels are more likely to hold these views.

What is the research about?

Researchers analysed 15 demographic and health surveys conducted in sub-Saharan Africa between 2015 and 2020. Data on an estimated 318,000 adults (ages 15 and above, 69% women) was analysed.

People were classified as having a discriminatory attitude towards people with HIV if they answered no to the questions: ‘Would you buy vegetables from a vendor with HIV?’, and ‘Should children with HIV be allowed to attend school with children without HIV?’

Not only did researchers calculate the proportion of people holding discriminatory attitudes, they examined the factors associated with holding these views.

Why is this research important?

Stigma and discrimination against people with HIV is one of the biggest barriers to ending AIDS.

It can lead to people with HIV being rejected by family, partners and friends, being denied healthcare, losing housing and income, and experiencing violence and abuse. Because of HIV-related stigma, many people do not test for HIV, start or stay on treatment, tell others they have HIV or ask for support.

Understanding more about HIV-related stigma and discrimination could help address this problem.

What did they find out?

Across all 15 countries, 47% of people had a discriminatory attitude towards people with HIV.

But there was huge variation between countries. In Malawi, 18% of people had a discriminatory attitude towards people with HIV. In Guinea, 80% of people did.  

Discriminatory attitudes were highest in Western Africa at 68%. They were lowest in Eastern Africa at 30%.

People were more likely to have a discriminatory attitude towards people with HIV if they were:

• younger
• had no formal education
• had a low socioeconomic status
• not married
• lived in a male-headed household
• did not use contraception
• had no exposure to television, radio or a newspaper
• had incorrect knowledge about HIV
• lived in an urban area
• came from Western Africa

HIV knowledge was assessed by asking people whether six statements about HIV were true or false. Around 40% of people got all six correct. These people were 60% less likely to have a discriminatory attitude towards people with HIV than people who got all six questions wrong.

What does this mean for HIV services?

As the analysis is based on existing survey data, it is not possible to draw conclusions about why, for example, people from pooer households hold more discriminatory attitudes or why younger people do.

But the finding that people with good knowledge about HIV are far less likely to hold discriminatory attitudes, and that people without a formal education are more likely to be discriminatory, shows how important education is, including education about HIV.

Designing HIV education and stigma-reduction initiatives in ways that engage people from groups that are more likely to hold discriminatory attitudes could help reduce HIV-related stigma. To do this, it is important to involve the people you are trying to reach and people with HIV in designing, running and evaluating these interventions so they work for all those involved.