AIDS and Behavior

, Volume 18, Issue 6, pp 1046–1053 | Cite as

Stigma Against People with HIV/AIDS in Rural Ethiopia, 2005 to 2011: Signs and Predictors of Improvement

  • Eshetu Girma
  • Lakew Abebe Gebretsadik
  • Michelle R. Kaufman
  • Rajiv N. Rimal
  • Sudhakar N. Morankar
  • Rupali J. Limaye
Original Paper

Abstract

This study sought to determine trends in and factors associated with stigma against people with HIV/AIDS in Ethiopia. Rural data from the 2005 and 2011 Demographic and Health Surveys were analyzed. HIV testing rates among males increased dramatically from 2005 to 2011 (8–35 %). Among females, testing rates dropped 10 % during the same period. HIV knowledge was associated with stigma, shown by a negative correlation in both data waves, but groups with higher knowledge tended to have lower stigma. Lower levels of knowledge were uniformly associated with higher levels of stigma, but higher levels of knowledge, combined with higher levels of education, were associated with lower levels of stigma in a multiplicative way. Improvements in knowledge can serve as an important intermediate process to behavior change. The found interaction suggests improvements in either education or knowledge can reduce stigma, and when both are improved, stigma reduction will be more dramatic.

Keywords

Stigma Knowledge HIV/AIDS Rural Ethiopia 

Resumen

Este estudio trata de determinar las tendencias y los factores asociados con la estigmatización de las personas con el VIH/SIDA en Etiopía. Datos de aéreas rurales obtenidos de las Encuestas Demográfica y de Salud del 2005 y 2011 fueron analizados para este estudio. Las tasas de pruebas de VIH entre hombres aumentó drásticamente entre el 2005 y el 2011 (8–35 %). Entre las mujeres, las tasas de pruebas del VIH tuvieron un descenso del 10 % en el mismo período. El conocimiento sobre el VIH se asoció con el estigma, que se muestra por una correlación negativa entre ambas ondas de datos, los grupos con mayor conocimiento tienden a tener menor estigma. Los niveles más bajos de conocimiento se asociaron de manera uniforme con mayores niveles de estigma y los niveles más altos de conocimiento, combinado con los niveles más altos de educación, se asociaron con menores niveles de estigma en un manera multiplicativa. Las mejorías en los conocimientos sobre el VIH pueden servir como un intermediario importante del proceso para el cambio de comportamiento. La interacción encontrada sugiere que mejoras en la educación o el conocimiento puede reducir el estigma, y cuando ambos se mejoran, la reducción del estigma será más dramática.

References

  1. 1.
    Goffman E. Stigma: notes on the management of spoiled identity. Englewood Cliffs: Prentice-Hall; 1963.Google Scholar
  2. 2.
    Herek GM. AIDS and stigma. Am Behav Sci. 1999;42:1106–16.CrossRefGoogle Scholar
  3. 3.
    Link BG, Phelan JC. Stigma and its public health implications. Lancet. 2006;367:528–9.PubMedCrossRefGoogle Scholar
  4. 4.
    Smith R. Language of the lost: an explication of stigma communication. Commun Theory. 2007;17:462–85.CrossRefGoogle Scholar
  5. 5.
    Roth J, Krishnan SP, Bunch E. Barriers to condom use: results from a study in Mumbai (Bombay), India. AIDS Educ Prev. 2001;13:65–77.PubMedCrossRefGoogle Scholar
  6. 6.
    Obermeyer CM, Osborn M. The utilization of resting and counseling for HIV: a review of the social and behavioral evidence. Am J Public Health. 2007;97:1762–74.PubMedCentralPubMedCrossRefGoogle Scholar
  7. 7.
    Varga CA, Sherman GG, Jones SA. HIV-disclosure in the context of vertical transmission: HIV-positive mothers in Johannesburg, South Africa. AIDS Care. 2006;18:952–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Eide M, Myhre M, Lindbaek M, Sundby J, Arimi P, Thior I. Social consequences of HIV-positive women’s participation in prevention of mother-to-child transmission programmes. Patient Educ Couns. 2006;60:146–51.PubMedCrossRefGoogle Scholar
  9. 9.
    Worthington C, Myers T. Factors underlying anxiety in HIV testing: risk perceptions, stigma, and the patient-provider power dynamic. Qual Health Res. 2003;13:636–55.PubMedCrossRefGoogle Scholar
  10. 10.
    Rintamaki LS, Davis TC, Skripkauskas S, Bennett CL, Wolf MS. Social stigma concerns and HIV medication adherence. AIDS Patient Care STDs. 2006;20:359–68.PubMedCrossRefGoogle Scholar
  11. 11.
    Sayles JN, Wong MD, Cunningham WE. The inability to take medications openly at home: does it help explain gender disparities in HAART use? J Women’s Health. 2006;15:173–81.CrossRefGoogle Scholar
  12. 12.
    Yang LH, Kleinman A, Link BG, Phelan JC, Lee S, Good B. Culture and stigma: adding moral experience to stigma theory. Soc Sci Med. 2007;64:1524–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Banteyerga H, Kidanu A, Nyblade L, MacQuarrie K, Pande R. Exploring HIV and AIDS stigma and related discrimination in Ethiopia: causes, manifestations, consequences and coping mechanisms. Washington DC: International Center for Research on Women; 2004.Google Scholar
  14. 14.
    Skinner D, Mfecane S. Stigma, discrimination and the implications for people living with HIV/AIDS in South Africa. Sahara. 2004;1:157–64.CrossRefGoogle Scholar
  15. 15.
    World Health Organization. Leading the health sector response to HIV/AIDS. Geneva: World Health Organization; 2003.Google Scholar
  16. 16.
    Global HIV Prevention Working Group. Access to HIV prevention: closing the gap. Bill and Melinda Gates Foundation and Henry J. Kaiser Foundation; 2003.Google Scholar
  17. 17.
    Kalichman SC, Simbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counseling and testing in a Black township in Cape Town, South Africa. Sex Transm Infect. 2003;79:442–7.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Genberg BL, Kawichai S, Chingono A, et al. Assessing HIV/AIDS stigma and discrimination in developing countries. AIDS Behav. 2008;12:772–80.PubMedCentralPubMedCrossRefGoogle Scholar
  19. 19.
    Central Statistical Agency, ICF International. Ethiopia Demographic and Health Survey 2011. Addis Ababa; 2012.Google Scholar
  20. 20.
    HIV/AIDS Prevention and Control Office (HAPCO). Multisectoral plan of action for universal access to HIV prevention, treatment, care and support in Ethiopia 2007–2010. Addis Ababa: HAPCO; 2007.Google Scholar
  21. 21.
    Lifson AR, Demissie W, Tadesse A, et al. HIV/AIDS stigma-associated attitudes in a rural Ethiopian community: characteristics, correlation with HIV knowledge and other factors, and implications for community intervention. BMC Int Health Hum Rights. 2012;12:6. doi:10.1186/1472-698X-12-6.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Solomon T, Haileamlak A, Girma B. Effect of access to antiretroviral therapy on stigma, Jimma University Hospital, Southwest Ethiopia. Ethiop J Health Sci. 2008;18:25–32.Google Scholar
  23. 23.
    Central Statistical Agency, ICF International. Ethiopia Demographic and Health Survey 2005. Addis Ababa; 2006.Google Scholar
  24. 24.
    Ethiopia Ministry of Health. Health sector development programme IV (2010–2015). Addis Ababa: FMOH; 2010.Google Scholar
  25. 25.
    Hladik W, Shabbir I, Jelaludin A, Woldu A, Tsehaynesh M, Tadesse W. HIV/AIDS in Ethiopia: where is the epidemic heading? Sex Transm Infect. 2006;82(suppl 1):i32–5.PubMedCentralPubMedCrossRefGoogle Scholar
  26. 26.
    Shabbir I, Larson CP. Urban to rural routes of HIV infection spread in Ethiopia. J Trop Med Hyg. 1995;98:338–42.PubMedGoogle Scholar
  27. 27.
    Ministry of Health. Report on the 2009 round antenatal care sentinel HIV surveillance in Ethiopia. Addis Ababa: FMOH; 2011.Google Scholar
  28. 28.
    Leta TH, Sandoy IF, Fylkesnes K. Factors affecting voluntary HIV counseling and testing among men in Ethiopia: a cross-sectional survey. BMC Public Health. 2012;12:438–49.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Ministry of Health. Report on progress towards implementation of the UN Declaration of Commitment on HIV/AIDS 2010. Addis Ababa: Federal Democratic Republic of Ethiopia Federal HIV/AIDS Prevention and Control Office; 2010.Google Scholar
  30. 30.
    Falnes EF, Moland KM, Tylleskar T, de Paoli MM, Msuya SE, Engebretsen IM. “It is her responsibility”: partner involvement in prevention of mother to child transmission of HIV programmes, northern Tanzania. J Int AIDS Soc. 2011;14(1):21.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Byamugisha R, Tumwine JK, Semiyaga N, Tylleskar T. Determinants of male involvement in the prevention of mother-to-child transmission of HIV programme in Eastern Uganda: a cross-sectional survey. Reprod Health. 2010;7:12.PubMedCentralPubMedCrossRefGoogle Scholar
  32. 32.
    Theuring S, Mbezi P, Luvanda H, Jordan-Harder B, Kunz A, Harms G. Male involvement in PMTCT services in Mbeya Region, Tanzania. AIDS Behav. 2009;13(Suppl 1):92–102.PubMedCrossRefGoogle Scholar
  33. 33.
    Rimal RN. Closing the knowledge-behavior gap in health promotion: the mediating role of self-efficacy. Health Comm. 2000;12:219–37.CrossRefGoogle Scholar
  34. 34.
    Rimal RN, Flora JA, Schooler C. Achieving improvements in overall health orientation: effects of campaign exposure, information seeking, and health media use. Commun Res. 1999;26:322–48.CrossRefGoogle Scholar
  35. 35.
    Genberg BL, Hlavka Z, Konda KA, et al. A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Soc Sci Med. 2009;68(12):2279–87.PubMedCrossRefGoogle Scholar
  36. 36.
    Pettifor A, MacPhail C, Suchindran S, Delany-Moretlwe S. Factors associated with HIV testing among public sector clinic attendees in Johannesburg, South Africa. AIDS Behav. 2010;14(4):913–21.PubMedCrossRefGoogle Scholar
  37. 37.
    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(2):170–86.PubMedCrossRefGoogle Scholar
  38. 38.
    Zuch M, Lurie M. ‘A virus and nothing else’: the effect of ART on HIV-related stigma in rural South Africa. AIDS Behav. 2012;16(3):564–70.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Eshetu Girma
    • 1
  • Lakew Abebe Gebretsadik
    • 1
  • Michelle R. Kaufman
    • 2
  • Rajiv N. Rimal
    • 3
  • Sudhakar N. Morankar
    • 1
  • Rupali J. Limaye
    • 2
  1. 1.Department of Health Education, College of Public Health and Medical SciencesJimma UniversityJimmaEthiopia
  2. 2.Center for Communication ProgramsJohns Hopkins University Bloomberg School of Public HealthBaltimoreUSA
  3. 3.Department of Prevention and Community HealthGeorge Washington University School of Public Health and Health ServicesWashingtonUSA

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