The Impact of Universal Access to Antiretroviral Therapy on HIV Stigma in Botswana

In the current study, the researchers sought to examine the impact of treatment access on HIV stigma in Botswana three years after the introduction of a national universal antiretroviral treatment program.

Prevalence and correlates of HIV stigma were studied using a population-based survey of 1,268 adults in 2004. Multivariate logistic regression was employed to assess correlates of stigmatizing attitudes and a new measure, anticipated HIV stigma.

Of participants, 38 percent reported at least one stigmatizing attitude: 23 percent would not purchase food from a shopkeeper with HIV, while 5 percent would not care for an HIV-infected relative. Seventy percent reported at least one measure of anticipated stigma: 54 percent anticipated ostracism after testing HIV-positive, and 31 percent anticipated mistreatment at work. Perceived access to antiretroviral therapy was strongly and independently associated with decreased odds of holding stigmatizing attitudes (adjusted odds ratio=0.42, 95 percent confidence interval=0.24-0.74) and of anticipated stigma (AOR=0.09; 95 percent CI=0.03, 0.30).

"Our findings suggest that antiretroviral therapy access may be a factor in reducing HIV stigma," the researchers concluded. "Nevertheless, the persistence of stigmatizing attitudes and significant anticipated stigma suggest that HIV stigma must be a target for ongoing intervention."

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