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William R. Wolfe, MD, Sheri D. Weiser, MD, MPH, Karen Leiter, JD, MPH, Wayne T. Steward, PhD, MPH, Fiona Percy-de Korte, DPH, Nthabiseng Phaladze, PhD, Vincent Iacopino, MD, PhD and Michele Heisler, MD, MPA

At the time of the study, William Wolfe, Sheri Weiser, Karen Leiter, Fiona Percy-de Korte, Vincent Iacopino, and Michele Heisler were with Physicians for Human Rights, Cambridge, MA. William Wolfe was also with the Department of Psychiatry, University of California, San Francisco. Sheri Weiser and Wayne Steward were with the Center for AIDS Prevention Studies, University of California, San Francisco. Nthabiseng Phaladze was with the Department of Nursing, University of Botswana, Gaborone. Vincent Iacopino was affiliated with the Department of Medicine, University of Minnesota, Minneapolis. Michele Heisler was with the Veterans Affairs Ann Arbor Health System, Ann Arbor, MI, and the Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor.

Correspondence: Requests for reprints should be sent to William Wolfe, Posttraumatic Stress Disorder Program, Box 116P, SF Veterans Affairs Medical Center, 4150 Clement St, San Francisco, CA 94121 (e-mail: william.wolfe{at}ucsf.edu).

Objectives. We sought to examine the impact of treatment access on HIV stigma in Botswana 3 years after the introduction of a national program of universal access to antiretroviral therapy.

Methods. We studied the prevalence and correlates of HIV stigma in a population-based study of 1268 adults in Botswana in 2004. We used multivariate logistic regression to assess correlates of stigmatizing attitudes and a new measure, anticipated HIV stigma.

Results. Overall, 38% of participants had at least 1 stigmatizing attitude: 23% would not buy food from a shopkeeper with HIV; 5% would not care for a relative with HIV. Seventy percent reported at least 1 measure of anticipated stigma: 54% anticipated ostracism after testing positive for HIV, and 31% anticipated mistreatment at work. Perceived access to antiretroviral therapy was strongly and independently associated with decreased odds of holding stigmatizing attitudes (adjusted odds ratio [AOR] = 0.42; 95% confidence interval [CI] = 0.24, 0.74) and of anticipated stigma (AOR = 0.09; 95% CI = 0.03, 0.30).

Conclusions. Our findings suggest that antiretroviral therapy access may be a factor in reducing HIV stigma. Nevertheless, the persistence of stigmatizing attitudes and significant anticipated stigma suggest that HIV stigma must be a target for ongoing intervention.

This article has been cited by other articles:

				A. Gamper, S. Nathaniel, and I. J. Robbe UNIVERSAL ACCESS TO ANTIRETROVIRAL THERAPY AND HIV STIGMA IN BOTSWANA Am J Public Health, June 1, 2009; 99(6): 968 - 969. [Full Text] [PDF]