Original Article

Annals of Behavioral Medicine

, Volume 46, Issue 3, pp 285-294

Internalized Stigma, Social Distance, and Disclosure of HIV Seropositivity in Rural Uganda

  • Alexander C. TsaiAffiliated withChester M. Pierce, MD Division of Global Psychiatry, Department of Psychiatry, Massachusetts General Hospital (MGH)MGH Center for Global HealthHarvard Medical SchoolCenter for Global Health, Room 1529-E3, Massachusetts General Hospital Email author 
  • , David R. BangsbergAffiliated withMGH Center for Global HealthHarvard Medical SchoolMbarara University of Science and Technology
  • , Susan M. KegelesAffiliated withCenter for AIDS Prevention Studies, Department of Medicine, University of California at San Francisco (UCSF)
  • , Ingrid T. KatzAffiliated withHarvard Medical SchoolDepartment of Medicine, Brigham and Women’s Hospital
  • , Jessica E. HabererAffiliated withMGH Center for Global HealthHarvard Medical School
  • , Conrad MuzooraAffiliated withMbarara University of Science and Technology
  • , Elias KumbakumbaAffiliated withMbarara University of Science and Technology
  • , Peter W. HuntAffiliated withDivision of HIV/AIDS, San Francisco General Hospital at UCSF
  • , Jeffrey N. MartinAffiliated withUCSF Department of Epidemiology and Biostatistics
    • , Sheri D. WeiserAffiliated withCenter for AIDS Prevention Studies, Department of Medicine, University of California at San Francisco (UCSF)Division of HIV/AIDS, San Francisco General Hospital at UCSF

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Abstract

Background

HIV is highly stigmatized, compromising both treatment and prevention in resource-limited settings.

Purpose

We sought to study the relationship between internalized HIV-related stigma and serostatus disclosure and to determine the extent to which this association varies with the degree of social distance.

Methods

We fit multivariable Poisson regression models, with cluster-correlated robust estimates of variance, to data from 259 persons with HIV enrolled in an ongoing cohort study in rural Uganda.

Results

Persons with more internalized stigma were less likely to disclose their seropositivity. The magnitude of association increased with social distance such that the largest association was observed for public disclosures and the smallest association was observed for disclosures to sexual partners.

Conclusions

Among persons with HIV in rural Uganda, internalized stigma was negatively associated with serostatus disclosure. The inhibiting effect of stigma was greatest for the most socially distant ties.

Keywords

HIV Social stigma Disclosure Uganda