Annals of Behavioral Medicine

, Volume 46, Issue 3, pp 285–294 | Cite as

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

  • Alexander C. Tsai
  • David R. Bangsberg
  • Susan M. Kegeles
  • Ingrid T. Katz
  • Jessica E. Haberer
  • Conrad Muzoora
  • Elias Kumbakumba
  • Peter W. Hunt
  • Jeffrey N. Martin
  • Sheri D. Weiser
Original Article



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


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.


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.


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.


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.


HIV Social stigma Disclosure Uganda 



We thank the Uganda AIDS Rural Treatment Outcomes (UARTO) study participants who made this study possible by sharing their experiences; Nozmo F.B. Mukiibi for his contributions to study design and implementation; and Annet Kembabazi and Annet Kawuma for providing study coordination and administrative support. While these individuals are acknowledged for their assistance, no endorsement of manuscript contents or conclusions should be inferred. A preliminary version of this analysis was presented in part at the 18th Conference on Retroviruses and Opportunistic Infections, Boston, Massachusetts, USA, March 2, 2011.

Conflicts of Interest

The authors have no conflicts of interest to disclose.

Source of Funding

This study was funded by U.S. National Institutes of Health R01 MH-054907, K23 MH-079713 and MH-079713-03S1, and P30 AI-027763. Additionally, the authors acknowledge the following sources of salary support: K23 MH-096620 (Tsai); K24 MH-087227 (Bangsberg); a Scholar Award through the Harvard University Center for AIDS Research (P30 AI-060354), the Eleanor and Miles Shore 50th Anniversary Fellowship Program for Scholars in Medicine, the Harvard Global Health Institute, and K23 MH-097667 (Katz); K23 MH-087228 (Haberer); and the Burke Family Foundation (Weiser).


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Copyright information

© The Society of Behavioral Medicine 2013

Authors and Affiliations

  • Alexander C. Tsai
    • 1
    • 2
    • 3
    • 9
  • David R. Bangsberg
    • 2
    • 3
    • 4
  • Susan M. Kegeles
    • 5
  • Ingrid T. Katz
    • 3
    • 6
  • Jessica E. Haberer
    • 2
    • 3
  • Conrad Muzoora
    • 4
  • Elias Kumbakumba
    • 4
  • Peter W. Hunt
    • 7
  • Jeffrey N. Martin
    • 8
  • Sheri D. Weiser
    • 5
    • 7
  1. 1.Chester M. Pierce, MD Division of Global Psychiatry, Department of PsychiatryMassachusetts General Hospital (MGH)BostonUSA
  2. 2.MGH Center for Global HealthBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.Mbarara University of Science and TechnologyMbararaUganda
  5. 5.Center for AIDS Prevention Studies, Department of MedicineUniversity of California at San Francisco (UCSF)San FranciscoUSA
  6. 6.Department of Medicine, Brigham and Women’s HospitalBostonUSA
  7. 7.Division of HIV/AIDS, San Francisco General Hospital at UCSFSan FranciscoUSA
  8. 8.UCSF Department of Epidemiology and BiostatisticsSan FranciscoUSA
  9. 9.Center for Global Health, Room 1529-E3, Massachusetts General HospitalBostonUSA

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