Association Between Perceived Community HIV-AIDS Stigma and HIV Testing Behaviors Among High-Risk Heterosexuals in Dallas and Houston, Texas: An Analysis of the National HIV Behavioral Surveillance System

Abstract

Background: Stigma-related behaviors place a great burden on people with HIV (PWH) or at risk of infection. For high-risk populations, perceived community HIV/AIDS stigma (PCHAS) may prevent early HIV testing, treatment, and care. The objective of this study was to assess the prevalence of PCHAS and its association with sociodemographic characteristics and HIV testing behaviors among high-risk heterosexuals in Dallas and Houston, Texas. Methods: Data from 1,003 high-risk heterosexuals recruited using respondent-driven sampling in 2013 and obtained from the National HIV Behavioral Surveillance system in Dallas and Houston, Texas were used for this study. Data procured were subjected to descriptive and inferential statistics that included frequency run, chi-square test and univariate logistic regression models to explore the associations between perceived community HIV/AIDS stigma index (PCHASi) and HIV testing behaviors, and sociodemographic characteristics. Results: Participants in both cities were primarily Black/African American, of low income, under poverty level, and uninsured. PCHAS was prevalent in Dallas (58.2%) and Houston (57.5%). The majority of participants in Dallas (76.7%) and Houston (86.6%) indicated ever getting tested for HIV, and about a third had tested at least once in the past 2 years. PCHAS was more common among Hispanics/Latinos (p=0.013) in Houston, and annual income (p=0.032), and homelessness (p=0.016) in the past 12 months were associated with PCHAS in Dallas. Participants in Dallas who were afraid of finding out if they had HIV (PR: 4.41, 95% CI: 1.40-13.9) and those who gave other reasons (PR: 2.64, 95%CI: 1.17-5.95) for not testing for HIV in the past year were more likely to perceive community-level support for the rights of PWH. In Houston, participants who had ever tested for HIV (PR: 2.26, 95% CI: 1.27-3.99) and those who tested 3 times (PR: 3.11, 95% CI: 1.18-8.19) in the past 2 years perceived community-level unfriendliness to PWH. Conclusion: Our study did not establish any clear relationship between PCHAS and HIV testing behaviors. However, perceived community-level fears and unfriendliness to PWH were associated with selected HIV testing behaviors suggesting that HIV knowledge and education at individual- and community-level may be important targets for intervention. Future research should consider the role of social and cultural norms in influencing the relationship between PCHAS and HIV testing behaviors.