Abstract #66  -  Socio-economic status and HIV and AIDS stigma in Tanzania
Authors:   Presenting Author:   Dr Mbaraka Amuri - Ifakara Health Institute
Additional Authors:  Dr Mbaraka  Amuri, Mr Steve Mitchell, Dr Anne Cockcroft, Prof Neil Andersson,
Aim: Tanzania has a generalised AIDS epidemic but the estimated adult HIV prevalence of 6% is much lower than in many countries in Southern Africa. HIV infection rates are reportedly higher in urban areas, among women, and among those with more education. Less than half of young adults are reported to have good knowledge about HIV transmission. Stigmatising attitudes are likely to be common in these circumstances. We examined the association between socio-economic status and other relevant variables and HIV and AIDS stigma in Tanzania mainland.
Method / Issue: In 2007 trained field teams interviewed adults aged 16-60 years in a national random cluster sample. We examined associations between socio-economic and other variables and stigma (belief that HIV/AIDS is punishment for sinning), in bivariate then multivariate analysis, with an adjustment for clustering. We report on associations in the final model, with the adjusted Odds Ratio and cluster-adjusted 95% confidence intervals. The variables we examined included: age, sex, marital status, education, urban or rural residence, household income, food security, sources of information about HIV/AIDS, discussion about HIV/AIDS, experience of intimate partner violence, and choice disability (defined as those who said they would have sex if their partner refused a condom and thought their partner could be at risk of HIV).
Results / Comments: We interviewed 1130 men and 1803 women. Over half (55%) believed that HIV/AIDS was punishment for sinning. Other forms of stigma were less common. Only 20% considered people with HIV or AIDS must live apart from others; and just 14% said they would not provide care for someone with HIV or AIDS if they had the means to do so. Taking other variables into account, poverty was significantly associated with stigma. People who did not have enough food in the last week were more likely to believe HIV/AIDS was punishment for sinning (OR 1.29, 95% CI 1.06-1.59). Other groups more likely to hold this attitude were: those with less than primary education (OR 1.29, 95%CI 1.03–1.62); those who had experienced partner violence in the past year (OR 1.40, 95%CI 1.12–1.75); those who were choice-disabled (OR 1.36, 95%CI 1.08-1.71); and those living in rural areas (OR 1.76, 95%CI 1.06–2.90). We found no significant difference in level of stigma between males and females, or between those who had heard about HIV/AIDS from different sources.
Discussion: The level of HIV and AIDS stigma in Tanzania is high, especially among the disadvantaged: less educated, poor people in rural areas. Other vulnerable groups – survivors of violence and the choice-disabled – are also more likely to have stigmatising beliefs. This may adversely affect their own behaviour (such as testing and seeking treatment for HIV) as well as their response to others infected with HIV. HIV prevention interventions should take account of stigma, especially among the disadvantaged, and take care not to increase it.
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