Effect of media use on HIV-related stigma in Sub-Saharan Africa: a cross-sectional study.

Mesfin Awoke Bekalu,Steven Eggermont,Kasisomayajula Viswanath,Shoba Ramanadhan,Mona R Loutfy

doi:10.1371/journal.pone.0100467

Mesfin Awoke Bekalu, Steven Eggermont + Show 3 more

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https://doi.org/10.1371/journal.pone.0100467

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Abstract

It is known that HIV-related stigma hinders prevention efforts. Previous studies have documented that HIV-related stigma may be associated with socioeconomic and socioecological factors. Mass media use may moderate this association, but there is limited research addressing that possibility. In this study, based on cross-sectional data pooled from the 2006–2011 Demographic and Health Surveys of 11 sub-Saharan African countries (N = 204,343), we investigated the moderating effects of exposure to mass media on HIV-related stigma. Hierarchical regression analysis indicated that HIV-related stigma tends to be higher among rural residents and individuals with low levels of education and HIV knowledge, as well as those who do not know people living with HIV. Media use was generally associated with low levels of HIV-related stigma, and attenuated the gap between individuals with high and low educational levels. However, the effect of mass media was found to be stronger among urbanites rather than among rural residents, which could lead to a widening gap between the two groups in endorsement of HIV-related stigma. The implication of this study regarding the effect of media use on HIV-related stigma in sub-Saharan Africa is twofold: 1) mass media may have the potential to minimize the gap in HIV-related stigma between individuals with high and low educational levels, and hence future efforts of reducing HIV-related stigma in the region may benefit from utilizing media; 2) due perhaps to low media penetration to rural sub-Saharan Africa, mass media could have the unintended effect of widening the urban-rural gap further unless other more customized and rural-focused communication interventions are put in place.

Highlights

HIV-related stigma is one of the principal factors that undermine public health efforts to combat the epidemic [1]
It is widely acknowledged that HIV-related stigma poses a significant threat to the effectiveness of prevention efforts targeted at both the general public and people living with HIV (PLH) [2,3,4]
A systematic review assessing the role of HIV-related stigma in prevention efforts found that stigmatizing attitudes and experiences of stigmatization are significantly associated with increased unsafe sexual practices, decreased utilization of biomedical-related prevention services, use of prevention of mother-to-child transmission (PMTCT) practices, and utilization of HIV testing and antiretroviral treatment (ART) [10]

Summary

Introduction

HIV-related stigma is one of the principal factors that undermine public health efforts to combat the epidemic [1]. It is widely acknowledged that HIV-related stigma poses a significant threat to the effectiveness of prevention efforts targeted at both the general public and people living with HIV (PLH) [2,3,4]. It is significantly associated with depressive symptoms, greater HIVrelated symptoms and poorer adherence to medication among PLH [5,6,7], and lack of utilization of HIV testing and maternity services in the general population [8,9]. In sub-Saharan Africa, the epicentre of the epidemic and the region that the present study addresses, several studies have shown that HIV-related stigma is associated with reduced levels of different HIV preventive practices, such as HIV testing [8], and ART and PMTCT utilization [3,4] in both the general public and PLH

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