AIDS and Behavior

, Volume 18, Issue 5, pp 958–965 | Cite as

Different Dimensions of HIV-Related Stigma May Have Opposite Effects on HIV Testing: Evidence Among Young Men and Women in South Africa

Original Paper


Although HIV-related stigma in general is known to deter HIV-testing, the extent to which different dimensions of stigma independently influence testing behaviour is poorly understood. We used data on young black men (n = 553) and women (n = 674) from the 2009 Cape Area Panel Study to examine the independent effects of stigmatising attitudes, perceived stigma and observed enacted stigma on HIV-testing. Multivariate logistic regression models showed that stigma had a strong relationship with HIV-testing among women, but not men. Women who held stigmatising attitudes were more likely to have been tested (OR 3, p < 0.01), while perceived stigma (OR 0.61, p < 0.1) and observed enacted stigma (OR 0.42, p < 0.01) reduced the odds significantly of women having had an HIV test. Our findings highlight that different dimensions of stigma may have opposite effects on HIV testing, and point towards the need for interventions that limit the impact of enacted and perceived stigma on HIV-testing among women.


HIV/AIDS Stigmatisation HIV-testing Africa Women 



We would like to thank Muthoni Ngatia, Atheendar Venkataramani, David Maughan-Brown and Rebecca Maughan-Brown for helpful comments and suggestions. Brendan Maughan-Brown is grateful for funding from the National Research Foundation (NRF) Research Chair in Poverty and Inequality Research for his Postdoctoral Research Fellowship. Opinions expressed and conclusions arrived at, are those of the authors and are not necessarily to be attributed to the NRF.


  1. 1.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365:493–505.PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Williams B, Lima V, Gouws E. Modelling the impact of antiretroviral therapy on the epidemic of HIV. Curr HIV Res. 2011;9:367–82.PubMedCentralPubMedCrossRefGoogle Scholar
  3. 3.
    Cambiano V, Rodger AJ, Phillips AN. “Test-and-treat”: the end of the HIV epidemic? Curr Opin Infect Dis. 2011;24:19–26.PubMedCrossRefGoogle Scholar
  4. 4.
    Forsyth AD, Valdiserri RO. Reaping the prevention benefits of highly active antiretroviral treatment: policy implications of HIV Prevention Trials Network 052. Curr Opin HIV AIDS. 2012;7:111–6.PubMedCrossRefGoogle Scholar
  5. 5.
    Mayer KH. Antiretrovirals for HIV prevention: translating promise into praxis. Lancet. 2011;378:206–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Matovu JKB, Makumbi FE. Expanding access to voluntary HIV counselling and testing in sub-Saharan Africa: alternative approaches for improving uptake, 2001–2007. Trop Med Int Health. 2007;12:1315–22.PubMedCrossRefGoogle Scholar
  7. 7.
    Babalola S. Readiness for HIV testing among young people in northern Nigeria: the roles of social norm and perceived stigma. AIDS Behav. 2007;11:759–69.PubMedCrossRefGoogle Scholar
  8. 8.
    Berendes S, Rimal RN. Addressing the slow uptake of HIV testing in Malawi: the role of stigma, self-efficacy, and knowledge in the Malawi BRIDGE Project. J Assoc Nurses AIDS. 2011;22:215–28.CrossRefGoogle Scholar
  9. 9.
    Hosseinzadeh H, Hossain SZ, Bazargan-Hejazi S. Perceived stigma and social risk of HIV testing and disclosure among Iranian-Australians living in the Sydney metropolitan area. Sex Health. 2012;9:171–7.PubMedGoogle Scholar
  10. 10.
    Kalichman S, Simbayi L. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town South Africa. BMJ. 2003;79:442–7.Google Scholar
  11. 11.
    Koku EF. Stigma, sexual risk and desire for HIV tests in Ghana. Sex Health. 2011;8:110–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Pitpitan EV, Kalichman SC, Eaton LA, et al. AIDS-related stigma, HIV testing, and transmission risk among patrons of informal drinking places in Cape Town South Africa. Ann Behav Med. 2012;43:362–71.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Pulerwitz J, Michaelis A, Lippman S, Chinaglia M, Dıá J. HIV-related stigma, service utilization, and status disclosure among truck drivers crossing the Southern borders in Brazil. AIDS care. 2008;20:198–204.CrossRefGoogle Scholar
  14. 14.
    Sambisa W, Curtis S, Mishra V. AIDS stigma as an obstacle to uptake of HIV testing: evidence from a Zimbabwean national population-based survey. AIDS care. 2010;22:170–86.PubMedCrossRefGoogle Scholar
  15. 15.
    Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in Rural Kenya: results from the MAMAS Study. AIDS Behav. 2011;15:1111–20.PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Young SD, Hlavka Z, Modiba P, et al. HIV-related stigma, social norms, and HIV testing in Soweto and Vulindlela, South Africa: National Institutes of Mental Health Project Accept (HPTN 043). J Acquir Immune Defic Syndr. 2010;55:620–4.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Karim QA, Meyer-Weitz A, Mboyi L, et al. The influence of AIDS stigma and discrimination and social cohesion on HIV testing and willingness to disclose HIV in rural KwaZulu-Natal South Africa. Global Publ Health. 2008;3:351–65.CrossRefGoogle Scholar
  18. 18.
    Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13:1160–77.PubMedCrossRefGoogle Scholar
  19. 19.
    Herek G. Thinking about AIDS and stigma: a psychologist’s perspective. J Law Med Ethics. 2002;30:594–607.PubMedCrossRefGoogle Scholar
  20. 20.
    Joffe H. Risk and “The other”. Cambridge: Cambridge University Press; 1999.CrossRefGoogle Scholar
  21. 21.
    Deacon H. Towards a sustainable theory of health-related stigma: lessons from the HIV/AIDS literature. J Com Appl Soc Psychol. 2006;16:418–25.CrossRefGoogle Scholar
  22. 22.
    Deacon H, Stephney I, Prosalendis S. Understanding HIV/AIDS stigma: A theoretical and methodological analysis. Cape Town: HSRC, Social Cohesion and Integration Unit (SCI); 2005.Google Scholar
  23. 23.
    Green G. Attitudes towards people with HIV: are they as stigmatizing as people with HIV perceive them to be? Soc Sci Med. 1995;41:557–68.PubMedCrossRefGoogle Scholar
  24. 24.
    Zelaya C, Sivaram S, Johnson S, Srikrishnan A, Solomon S, Celentano D. HIV/AIDS stigma: reliability and validity of a new measurement instrument in Chennai India. AIDS Behav. 2008;12:781–8.PubMedCrossRefGoogle Scholar
  25. 25.
    Scambler G, Hopkins A. Being epileptic: coming to terms with stigma. Sociol Health Ill. 1986;8:26–43.CrossRefGoogle Scholar
  26. 26.
    Lam D, Ardington C, Branson N, et al. The Cape Area Panel Study: Overview and Technical Documentation. Cape Town: University Of Cape Town; 2012.Google Scholar
  27. 27.
    Actuarial Society of South Africa. ASSA 2008 HIV/AIDS projection model. Actuarial Society of South Africa; 2011.Google Scholar
  28. 28.
    Maughan-Brown B. Attitudes towards people with HIV/AIDS: stigma and its determinants amongst young adults in Cape Town, South Africa. South Afr Rev Sociol. 2006;37:165–88.CrossRefGoogle Scholar
  29. 29.
    Terwee C, Bot S, de Boer M, et al. Quality criteria were proposed for measurement properties of health status questionnaires. J Clin Epidemiol. 2007;60:34–42.PubMedCrossRefGoogle Scholar
  30. 30.
    Venkatesh KK, Madiba P, de Bruyn G, Lurie MN, Coates TJ, Gray GE. Who gets tested for HIV in a South African urban township? Implications for test and treat and gender-based prevention interventions. J Acquir Immune Defic Syndr. 2011;56:151–65.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Nattrass N, Maughan-Brown B, Seekings J, Whiteside A. Poverty, sexual behaviour, gender and HIV infection among young black men and women in Cape Town South Africa. Afr J AIDS Res. 2012;11:307–17.CrossRefGoogle Scholar
  32. 32.
    Simbayi L, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town South Africa. Soc Sci Med. 2007;64:1823–31.PubMedCrossRefGoogle Scholar
  33. 33.
    MacPhail C, Pettifor A, Moyo W, Rees H. Factors associated with HIV testing among sexually active South African youth aged 15–24 years. AIDS Care. 2009;21:456–67.PubMedCrossRefGoogle Scholar
  34. 34.
    Petros G, Airhihenbuwa C, Simbayi L, Ramlagan S, Brown B. HIV/AIDS and “othering” in South Africa: the blame goes on. Cult Health Sex. 2006;8:67–77.PubMedCrossRefGoogle Scholar
  35. 35.
    Leclerc-Madlala S. Demonising women in the era of AIDS: on the relationship between cultural constructions of both HIV/AIDS and femininity. Society in Transition. 2001;32:38–46.CrossRefGoogle Scholar
  36. 36.
    Turan J, Nyblade L. HIV-related Stigma as a Barrier to Achievement of Global PMTCT and Maternal Health Goals: a Review of the Evidence. AIDS Behav. 2013;17:2528–38.PubMedCrossRefGoogle Scholar
  37. 37.
    Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc. 2009;12:15.PubMedCentralPubMedCrossRefGoogle Scholar
  38. 38.
    Pulerwitz J, Michaelis A, Weiss E, Brown L, Mahendra V. Reducing HIV-related stigma: lessons learned from horizons research and programs. Public Health Rep. 2010;125(2):272–81.PubMedCentralPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Southern Africa Labour and Development Research Unit (SALDRU)University of Cape TownCape TownSouth Africa
  2. 2.RTI InternationalWashingtonUSA

Personalised recommendations