Community Group Membership and Stigmatising Attitudes Towards People Living with HIV in Eastern Zimbabwe

Mercy Nhamo-Murire,Catherine Campbell,Simon Gregson

doi:10.1007/s10900-013-9741-6

Abstract

Stigmatising attitudes towards people living with HIV and AIDS (PLHIV) are hampering attempts to control HIV epidemics in sub-Saharan African countries. This study measures the effect of social capital, in the form of local community groups, in reducing stigma and tests a new explanatory framework for the association between community group membership and less stigmatising attitudes. Prospective data on membership of a wide range of different community groups and stigmatising attitudes (being unwilling to care for a relative with AIDS), collected from a general population cohort of 5,253 men and women aged 15–54 years in eastern Zimbabwe between 2003 and 2008 were analysed using multivariable logistic regression. 36 % of respondents were members of community groups throughout the study period. Individuals in community groups were less likely to express stigmatising attitudes towards PLHIV—3.4 versus 9.5 % (adjusted odds ratio = 0.46, p < 0.001). Discussions of care for PLHIV within groups, improved knowledge about AIDS, greater exposure to PLHIV, and increased uptake of HIV testing and counselling did not account for the association. Further work is needed to identify the mechanisms through which community participation can reduce stigma. Nevertheless, these findings suggest that promoting well-informed discussions about HIV within pre-existing community groups and involving these groups in stigma reduction programmes could be effective means of reducing stigma at the grassroots level.

Highlights

Stigmatising attitudes towards people living with HIV and AIDS (PLHIV) have long been one of the major problems facing infected individuals and hampering attempts to control HIV epidemics in Zimbabwe [16] and elsewhere [2]
In the sex- and age-adjusted analysis, individuals aged over 20 years at baseline, those with secondary education, and those expressing willingness to care for a relative with AIDS at baseline each were significantly (p \ 0.05) less likely to express stigmatising attitudes towards PLHIV at follow-up
In predominantly rural areas in Manicaland province in eastern Zimbabwe where, as elsewhere in the country, HIV prevalence has been declining but remains at a high level [18, 20], and at time when availability of ART services was still low, we found that men and women who participated in community groups were less likely than their peers to have stigmatising attitudes towards PLHIV

Summary

Introduction

Stigmatising attitudes towards people living with HIV and AIDS (PLHIV) have long been one of the major problems facing infected individuals and hampering attempts to control HIV epidemics in Zimbabwe [16] and elsewhere [2]. A number of approaches to reducing stigmatising attitudes have been identified [29] but relatively few of these have been shown to be effective [14]. One promising but little explored approach is the possibility that social capital, in the form of community group participation, might be a useful resource in challenging and reducing stigma. Community groups are rooted in the local social contexts within which individuals form attitudes towards PLHIV and could help to reduce stigma by providing opportunities for discussion and renegotiation of previously stigmatising social norms. Social capital has been found to be associated with reduced rates of HIV acquisition [8, 21, 36] and with a number of factors linked to the risk of infection including alcohol consumption [8], intimate partner violence [36] and sexual behaviour [11]

Methods

Results

Conclusion