Domains Of Stigma Research Articles

Sex workers’ experiences following the Canterbury earthquakes: Recovery and rebuild

The social and occupational stigma that impacts on sex workers’ resilience following a significant disaster has received little to no attention. To remedy this gap, this paper explores how experiences of stigma have impacted sex workers lives following the 2010-2011 Canterbury earthquakes in Aotearoa New Zealand. We set out to understand how stigma enabled and constrained sex workers’ ability to respond to and recover from the earthquakes. We coalesce knowledge from across the domains of sex work, social stigma and disaster management. Semi-structured, in person interviews were held with sex workers who worked during or after the time of the Canterbury earthquakes in Ōtautahi (Christchurch). Additional interviews were conducted with stakeholders who worked with or continued to support sex workers in Christchurch. From across these interviews, narrative tropes were identified, including the risks of divulging sex work in the aftermath of a disaster; navigating intersectional stigma and accessing help; addressing sex workers' unique needs following the earthquakes; and media as a site of stigma. This research aims to combat the negative effects of stigma by encouraging disaster management officials and associated services to attend to the needs of precariat communities during adverse events.

Reducing public stigma toward individuals with psychosis across race and gender: A randomized controlled trial of young adults

BackgroundSocial contact-based interventions effectively reduce stigma toward psychosis. We recently demonstrated the efficacy of a 90-second video intervention in reducing stigma. The current randomized controlled study presents four briefer videos differing in presenter's gender/race, with baseline, postintervention, and 30-day follow-up assessments. The study replicates previous findings and examine whether concordance of presenter's and viewer's race/gender enhanced the anti-stigma effect. MethodsUsing a crowdsourcing platform, we recruited 1993 participants ages 18–35 years to one of four brief video-based interventions (Black/White female, Black/White male presenters) or a nonintervention control condition. In the videos, a young presenter with psychosis humanized their illness through an evocative description of living a meaningful and productive life. ResultsGroup-by-time ANOVA showed a significant group-by-time interaction for the total score of all five stigma domains: social distance, stereotyping, separateness, social restriction, and perceived recovery. One-way ANOVA showed greater reductions in video intervention groups than control at post-intervention and 30-day follow-up, but no differences between video groups. Matching race/gender did not further reduce stigma. ConclusionsThis randomized controlled study replicated and extended previous research findings, by showing stigma reduction across videos that differ in the presenter's gender and race, thus enhancing generalizability. The videos described the experience of psychosis and reduced stigma, suggesting their potential utility on social media platforms to increase the likelihood of seeking services and ultimately may improve access to care among young individuals with psychosis. Future research should address intersectional stigma experiences by focusing on race/gender and culturally tailoring the narrative.

A systematic review of disease related stigmatization in patients living with prostate cancer.

Prostate cancer has been shown to be susceptible to significant stigmatisation, because to a large extent it is concealable, it has potentially embarrassing sexual symptoms and has significant impact on the psychosocial functioning. This review included studies that focused on qualitative and/or quantitative data, where the study outcome was prostate cancer and included a measure of stigmatization. Electronic databases (CINAHL, Medline, PubMed, PsycInfo, Cochrane Library, PROSPERO, and the Joanna Briggs Institute) and one database for grey literature Opengrey.eu, were screened. We used thematic analysis, with narrative synthesis to analyse these data. We assessed risk of bias in the included studies using the RoBANS. In total, 18 studies met review inclusion criteria, incorporating a total of 2295 participants. All studies recruited participants with prostate cancer, however four studies recruited participants with other cancers such as breast cancer and lung cancer. Of the 18 studies, 11 studies evaluated perceived or felt stigma; four studies evaluated internalised or self-stigma; three studies evaluated more than one stigma domain. We found that patients living with prostate cancer encounter stigmatisation that relate to perception, internalisation, and discrimination experiences. We also identified several significant gaps related to the understanding of prostate cancer stigmatization, which provides an opportunity for future research to address these important public health issues. This systematic review protocol is registered with PROSPERO, the international prospective register of systematic reviews in health and social care. Registration number: CRD42020177312.

Longitudinal impact of a poverty simulation on healthcare practitioners' attitudes towards poverty

BackgroundMany clinicians have limited knowledge about the challenges of living in poverty, leading to stigma and differential treatment in healthcare settings. A poverty simulation event may help clinicians gain empathy and knowledge about the ways that poverty impacts health and well-being. PurposeThis study evaluated the impact of a poverty simulation and the effect of personal characteristics on clinicians' attitudes towards poverty. MethodsUsing a prospective longitudinal mixed-methods study design, a convenience sampling of clinicians from a freestanding children's hospital was recruited to participate in a poverty simulation event. The 21-item Attitudes Towards Poverty (ATP) tool was administered pre- and post-simulation and at 3 follow-up time points. Multiple linear regression analysis and linear mixed effects models were used to analyze ATP data. Qualitative data were analyzed to identify broad themes. ResultsMean scores in the ATP domains of stigma and structural perspective increased post-simulation, but only stigma scores demonstrated sustained improvement. Scores in the personal deficiency domain remained unchanged. Being male, White, and having Liberal political views were associated with lower ATP scores in our data. Qualitative data show participants felt the simulation generated feelings of compassion and empathy. DiscussionSimulation participation improved ATP scores in two domains immediately post-event, suggesting the simulation positively impacted clinicians' attitudes towards poverty. Follow-up data suggest the impact of the simulation may be temporary. Translation to health education practiceExperiential learning activities, like poverty simulations, help foster awareness and empathy among clinicians but may not have long-term impact. Ongoing education is needed to create a workforce sensitized and equipped to care for families from all backgrounds.

Conceptualizations of suicide and suicide-related stigma in Latino communities in the United States.

Suicide continues to be a significant public health concern impacting all cultural and ethnic groups in the United States. Although prior studies indicate that Latino individuals die by suicide at lower rates than their non-Hispanic White or Asian peers, recent data in this area indicate that suicide rates for Latino individuals are rising. Currently, little is known about how Latino individuals perceive those who are experiencing suicidal ideation and the factors that are associated with stigma toward people contemplating self-harm. To address this gap, a convenience sample of 248 adults in the United States identifying as Latino participated in an experimental vignette study investigating their perceptions of persons experiencing suicidal ideation. Results show that generation of immigration significantly predicted various domains of stigma toward individuals with suicidal ideation. Older participants and participants with more children were associated with higher levels of stigma. The gender or age of the person experiencing suicidal ideation did not impact the levels of stigma across domains. Results indicate a need to increase the overall health literacy in relation to suicide within Latino communities, particularly in relation to early identification of suicidal ideation. Implications for future research and practice with Latino communities are offered. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Efeito da dança do ventre na função sexual e imagem corporal de pacientes em hormonioterapia para o câncer de mama - ensaio clínico randomizado

Abstract Introduction: Breast cancer is a public health problem because of its high incidence. Its often-mutilating treatment can cause serious problems with regard to body image and sexual function in these women. Belly dancing is a possible option to improve the femininity of these women. Objective: The aim of this two-arm randomized study was to determine the effect of practicing belly dancing on sexual function and body image in breast cancer patients undergoing adjuvant hormone therapy in Santa Catarina, Brazil. Methods: The study randomized 24 women (60 ± 10.4 years old) diagnosed with breast cancer, 11 in the intervention group (IG) and 13 in the control group (CG). A questionnaire was used to evaluate personal and clinical characteristics, body image (BIBCQ), and sexual function (FSFI). Results: On the body image scale, in the domains of body stigma (p = 0.002) and body concerns (p = 0.017), significant intergroup differences were found, with better body image for the IG in the post-intervention period when compared to the CG. In sexual function, no significant differences were found. Conclusion: Belly dancing as physical exercise helps improve body image in patients with breast cancer undergoing adjuvant treatment with hormone therapy.

Stigmatising views towards individuals with eating disorders: trends and associations from 1998 to 2008 using a repeated cross-sectional design.

Eating disorders are stigmatised. Little is known about whether stigma has decreased over time and which groups hold more stigmatising beliefs. To explore whether stigma towards eating disorders has changed between 1998 and 2008 and whether it varies by sociodemographic characteristics. We used the Office for National Statistics Omnibus surveys 1998 and 2008. As outcomes, we selected four questions eliciting participants' views on issues of blame and ability to recover, and compared their mean scores across eating disorders, depression and alcohol dependence in both years. We used multivariable linear regressions to investigate associations between sociodemographic characteristics and each stigma domain. In total, 2720 participants had data on all variables of interest. Compared with 1998, in 2008 stigmatising views towards eating disorders improved. In both years, participants believed it was easier to recover from eating disorders than depression or alcohol dependence. Respondents believed people with eating disorders were more to blame for their condition than those with depression, but less than those with alcohol dependence. Men, those with less formal education, and those from ethnic minority backgrounds were more likely to place greater blame on individuals for their mental illness. Men were more likely than women to think it was possible to recover from an eating disorder. Stigmatising attitudes towards people with eating disorders have improved over time, but are still greater than those observed for other mental illnesses. Improving eating disorder mental health literacy could help to reduce these negative views and lead to improved quality of life, greater help-seeking and better prognosis.

Stigma and Mental Health during COVID-19 New Normal Transition in Indonesia

Background: Social isolation and economic catastrophic became the main characters of the current pandemic.Historically, the strongest stigmas related to diseases were characterized as highly transmittable, potentiallylethal, and without remedy. All represented COVID-19 during the early transition into the new normal. Weaimed to analyzed stigma and economic stressors concerning mental health. Method: We conducted a crosssectionalonline survey of 1375 participants in Java, Indonesia. Mental health status evaluated with DASS-21. The presence of social and self-stigma related to Covid-19 assessed with a questionnaire developed basedon seven domains of public stigma. Demographics and other psychosocial stressors were assessed withan online questionnaire. Descriptive analyses and logistic regression had carried out. Result: A very highpercentage of perceived and anticipated self-stigma and social stigma revealed. Controlling demographicsfactors, clear self-stigma increased the risk for depression (2.323 (1.241-4.346), p<0.05), anxiety (2.134(1.205-3.777), p<0.05) and stress 3.931 (1.779-8.685), P<0.001). Clear social stigma increased the risk foranxiety (2.000 (1.066-3.756), p<0.05) but not on depression and stress.Conclusion: Ensuring basic needsfulfilment and eliminating stigma is critical for supporting mental health in the Covid-19 pandemic. Furtherresearch into the stigma-related risks is necessary because it represents an important need for interventionin public health.

Intervention to Reduce Stigma and Improve Knowledge of HPV and Cervical Cancer in Nigeria: A Community-Based Assessment.

We compared the effectiveness of an educational intervention at reducing stigma and improving knowledge of human papillomavirus (HPV) and cervical cancer among Nigerian men and women. We used a pre-/posttest design to deliver 2 educational interventions to 266 adults. Low knowledge was observed at baseline, which improved significantly post-intervention with no difference between groups. No significant changes were observed between groups in 5 out the 6 stigma domains. Health education was effective in improving knowledge. However, the lack of positive change in stigma shows urgent need for HPV and cervical cancer stigma reduction interventions.

Public perceptions of prejudice research: The double-edged sword faced by marginalized group researchers

Researchers from marginalized groups often make important social scientific discoveries about prejudice, particularly when they are members of the group under investigation (e.g., women studying sexism, Black Americans studying racism). But is the scientific integrity and validity of their work perceived differently by virtue of their membership in the marginalized group? Across three survey experiments conducted in the domains of weight stigma, racism, and sexism research (total N = 1317), we find that researchers from a marginalized group whose research focuses on prejudice against their ingroup face a double-edged sword. On one hand, they are perceived as having greater psychological standing and expertise in the research area owing to their personal experience and insight into the processes they are researching. This, in turn, facilitates greater trust in, and perceived legitimacy of, their research. On the other hand, their research is simultaneously considered less trustworthy and legitimate because it is perceived as being motivated by a vested interest, in terms of having a personal agenda in the research. These findings demonstrate the competing biases that affect public perceptions of marginalized group researchers and their work in the area of prejudice.

533-P: Diabetes Related Stigma among Black and Hispanic Young Adults (YA) with Type 1 Diabetes (T1D)

Objective: Young adults with T1D of racial/ethnic minority status suffer adverse outcomes compared with White peers. Diabetes-related stigma (DRS) is common and may contribute to poor outcomes in minority YA, but further study is needed. Methods: We recruited non-Hispanic Black and Hispanic YA with T1D from pediatric and adult diabetes centers at Montefiore Medical Center in the Bronx, NY for a qualitative study to explore YA lived experiences with T1D, challenges to diabetes self-management, and healthcare interactions. We conducted semi-structured individual interviews, which were audio-recorded, transcribed, and analyzed for common themes until thematic saturation was achieved. We coded for DRS in YA responses using the Diabetes Stigma Assessment Scale (DSAS), which includes three domains for stigma due to having diabetes: 1) treated differently, 2) blame and judgment, and 3) identity concerns. Results: We included 41 YA participants for analysis (mean age 21 yrs, 68% female, 73% Hispanic, 27% Black, mean HbA1c 10.3%). Seventy-eight percent of participants (n=32) qualified as having at least one experience consistent with DRS. Of those, approximately half of participants had experiences consistent with one domain of DRS, nine participants with two DRS domains, and three participants with all three domains. Each stigma domain (treated differently, blame and judgment, and identity concerns) was represented equally among participants with DRS experiences. Notably, several Black participants mentioned that they experienced race discrimination from healthcare providers related to diabetes self-management and outcomes. Conclusions: In this sample of minority YA with T1D, DRS prevalence was very high and had some race-specific associations. Greater recognition of DRS and its contribution to poor outcomes among YA with T1D belonging to racial/ethnic minority groups is needed. Disclosure G. Crespo-ramos: None. M. Finnan: None. J. S. Gonzalez: None. S. Agarwal: None. Funding National Institutes of Health (K23DK115896)

Development of the Experiences of Sex Work Stigma Scale Using Item Response Theory: Implications for Research on the Social Determinants of HIV

While HIV stigma has received significant attention, limited work has been conducted on the measurement of intersecting stigmas. We developed the Experiences of Sex Work Stigma (ESWS) scale in the Dominican Republic (DR) and Tanzania. We conducted in-depth interviews with 20 female sex workers (FSW) per country to identify scale domains followed by cognitive debriefing interviews to assess content validity. Items were administered in a survey to FSW in DR (n = 211) and Tanzania (n = 205). Factor analysis established four sex work stigma domains including: shame (internalized), dignity (resisted), silence (anticipated) and treatment (enacted). Reliability across domains ranged from 0.81 to 0.93. Using item response theory (IRT) we created context-specific domain scores accounting for differential item functioning between countries. ESWS domains were associated with internalized HIV stigma, depression, anxiety, sexual partner violence and social cohesion across contexts. The ESWS is the first reliable and valid scale to assess multiple domains of sex work stigma and can be used to examine the effects of this form of intersectional stigma on HIV-related outcomes across settings.

An Integrative Review of Measurement Instruments Used to Assess the Stigma That Affects People Who Use Drugs

This article aims to review how existing instruments to measure stigma affecting people who use drugs have been developed, which domains of stigma are measured, as well as metrics used to validate these instruments. Using the Whittemore and Knafl’s process for conducting an integrative review, six studies published between January 2002 and April 2019 were systematically analyzed. Overall, all the studies included had good methodological qualities. The results showed that the instruments measured one or more domain of stigma. However, most of these studies use already pre-validated instrument to measure stigma in mental health and adapt to fit the people who use drugs context. Based on the findings we therefore recommend that more studies exploring the experience of people who use drugs regarding stigma, and the perceptions of service provides rendering care to people who use drugs should be undertaken to develop relevant and context-specific stigma instruments.

Gender Differences in How the American Public Reacts to a Person With Mild-Stage Dementia

Many studies show that caregivers for those with Alzheimer’s Disease (AD) are disproportionately female, but few studies have investigated how public attitudes influence this gender disparity. We analyzed secondary data from an experimental study of public reactions to AD dementia. Analysis included 944 respondents who read a vignette about a man with mild stage dementia and completed a modified Family Stigma in Alzheimer’s Disease Scale (FS-ADS), which assesses 7 domains of stigma. Multivariable ordered logistic regression compared men and women on FS-ADS ratings. Women were less likely than men to endorse stronger negative aesthetic attributions (OR=0.75) and negative feelings (OR=0.76) and more likely to endorse stronger feelings of pity (OR=1.33; all p<0.05). No other differences were observed in FS-ADS domains (all p>0.05). The findings offer insights into relationships between gender and AD stigma, which may influence who is willing to become a caregiver for persons with AD and related dementias.

HIV-related stigma trends in the general population of India during an era of antiretroviral treatment expansion, 2005-16.

BackgroundIn India, which has the world’s third-largest HIV epidemic, the extent to which levels of HIV-related stigma have changed during an era of ART scale-up is unknown.MethodsWe analyzed data from the 2005-06 and 2015-16 National Family Health Surveys (NFHS) to estimate trends in two stigma domains among people in the general population: desires for social distance from people living with HIV (ie, unwillingness to interact) and fear of serostatus disclosure in the case of a hypothetical HIV infection. We fitted multivariable linear probability models to the data with year of NFHS as the explanatory variable and alternately specifying fear of disclosure or desires for social distance as the dependent variable. Analyses were stratified by sex, state, and high vs low HIV prevalence states.ResultsWe included data on 172 795 women and 159 194 men. Desires for social distance declined in 2015-16 compared with 2005-06 (38% in 2015-16 vs 43% in 2005-06; adjusted b = -0.046; 95% confidence interval (CI = -0.049 to -0.043; P < 0.001) but fear of serostatus disclosure increased (31% in 2005-06 vs 37% in 2015-16; adjusted b = 0.058; 95% CI = 0.055-0.062; P < 0.001). Declines in social distancing were more pronounced among men and in high HIV prevalence states. Increased fear of serostatus disclosure was greater among women and in high HIV prevalence states. There was significant variability in trends disaggregated by state.ConclusionsDuring the first decade of ART scale-up in India, fear of HIV serostatus disclosure in the general population increased despite a decline in desires for social distance.

The Extent of Stigma Experienced by the Caregivers of Patients with OCD and its Association With Caregiver Burden and Coping

Stigma related to psychiatric illness not only impact the patients but also have adverse consequences on the caregivers. Stigma can lead to poor quality of life, social restriction, and psychological morbidity. Not much data is available on the stigma among the caregivers of patients with Obsessive–Compulsive Disorder (OCD). To evaluate the extent of stigma experienced by the caregivers of patients with OCD and its association with caregiver burden and coping. In a cross-sectional study, 53 caregivers of patients with OCD were evaluated on the Stigma Scale for Caregivers of People with Mental Illness (CPMI), Family Burden Interview (FBI) Schedule, and Family Coping Questionnaire (FCQ). The mean age of the caregivers was 45.9 years, with the number of years of formal education was 8.6 (SD: 5.4) years. Majority of the caregivers were male and married, were the spouse of the patient with a mean duration caregiving at the time of assessment being 122.6 months. In terms of stigma, the highest level of stigma was seen in the affective domain, followed by behavioural domain and least in the cognitive domain of CPMI. On FBI the highest level of burden was seen in the domain of disruption of routine family activities, followed by disruption of family interaction, disruption of family leisure activities, financial burden, the effect on the physical health of others, and effect on mental health others. On FCQ, Positive communication and resignation were the most commonly used coping mechanisms. The least commonly used coping strategy was the patient's social involvement. All the domains of CPMI had a significant positive association with a total objective score of FBI. In terms of coping, a higher level of stigma was associated with lower use of social involvement (all domains of stigma), coercion (cognitive domain and total stigma), and avoidance (all domains except for affective domain) as coping mechanisms. Lower use of positive communication was associated with higher stigma in the behavioural domain. Those with a high objective burden had a higher level of stigma on the cognitive and behaviour domain of the CPMI. Caregivers of patients with OCD experience a high level of stigma. A higher level of stigma is associated with the more use of maladaptive coping like avoidance and higher caregiver burden. Accordingly, it can be said that there is a need to focus on the caregivers of patients with OCD to improve the overall outcome of the patients.

Understanding explanatory mechanisms for racial and ethnic differences in mental health stigma: the role of vertical individualism and right-wing authoritarianism

Background Mental health (MH) stigma is pervasive worldwide. Culturally sensitive stigma reduction programs are needed to reduce MH stigma. Aims To determine racial/ethnic and cultural predictors of stigma. Method The current study examined the relationship between cultural orientation (individualism-collectivism beliefs), race/ethnicity, and political beliefs (right-wing authoritarianism [RWA]). Participants (N = 951) from the United States completed an online survey for this cross-sectional study. Results Findings indicated that vertical individualism is a consistent, though modest, predictor of multiple dimensions of MH stigma, controlling for other predictors. Contrary to what was hypothesized, vertical individualism did not mediate the relationship between Asian-American race/ethnicity and MH stigma, but was found to mediate the relationship between RWA and stigma. A novel finding was that RWA mediated the relationship between African-American race/ethnicity and multiple MH stigma domains. Conclusions Findings therefore indicate that the endorsement of authoritarian views, rather than vertical-individualism (which advances the idea that everyone is in competition), is the primary mechanism of MH stigma differences between African-Americans and individuals from other racial/ethnic groups. A major implication from this study is that efforts to address MH stigma among specific cultural groups should incorporate a sensitivity to the role of both RWA and vertical individualism in facilitating stigma.

Validation of an adapted instrument to measure female genital fistula-related stigma

ABSTRACT Female genital fistula results in severe physical, psychological, and social sequelae. Qualitative research confirms stigma pervasiveness; however, no quantitative instrument exists to measure fistula-related stigma. We adapted an existing HIV-related stigma instrument to fistula-related stigma and assessed its reliability and validity. We recruited 60 Ugandan women seeking genital fistula surgery (December 2014–June 2015). We used exploratory factor analysis to explore the scale’s latent structure and evaluated internal consistency reliability with Raykov’s ρ statistic. We assessed construct validity through linear regression of stigma with quality of life, depressive symptoms and self-esteem. We retained 15 items across factors ‘enacted stigma’ and ‘internalised stigma’ (ρ = 0.960 and ρ = 0.748, respectively). Stigma was inversely associated with all quality of life domains; effect sizes were largest for environmental (enacted stigma, 0.69-point reduction) and psychological (internalised stigma, 0.67-point reduction) domains. Both stigma domains were associated positively with depressive symptoms and inversely with self-esteem, with 0.75 and 1.05-point increases in depressive symptoms and 0.45 and 0.77-point decreases in self-esteem for enacted and internalised stigma, respectively. Results suggest the reliability and validity of the adapted fistula stigma instrument. This instrument may help us understand stigma levels, compare stigma across individuals and communities, prioritise stigma-reduction strategies, and assess intervention impact.

Reducing Stigma Toward Individuals With Schizophrenia Using a Brief Video: A Randomized Controlled Trial of Young Adults

Stigma decreases healthcare seeking and treatment adherence and increases the duration of untreated psychosis among people with first-episode psychosis (FEP). This study evaluated the efficacy of a brief video-based intervention in reducing stigma among youth toward individuals with FEP and schizophrenia. We hypothesized that the social-contact-based video intervention group would reduce stigma more than written vignette and control groups, and the vignette more than the control group. Using Amazon Mechanical Turk, we recruited and assigned 1203 individuals aged 18-30 to either (a) video intervention, (b) written description of the same content ("vignette"), or (c) nonintervention control arm. In the 90-second video intervention, an empowered young woman with schizophrenia described her FEP and the aspects of successful coping with her everyday life difficulties, exposing the viewer to schizophrenia in the context of her personal narrative. Web-based self-report questionnaires assessed stigma domains, including social distance, stereotyping, separateness, social restriction, and perceived recovery. A MANOVA showed a significant between-group effects for all 5 stigma-related subscales (P < .001). Post hoc pairwise tests showed significant differences between video and vignette vs control for all 5 stigma domains. Video and vignette groups differed significantly on social distance, stereotyping, and social restriction. Secondary analyses revealed gender differences across stigma domains in the video group only, with women reporting lower stigma. A very brief social contact-based video intervention efficaciously reduced stigma toward individuals with FEP. This is the first study to demonstrate such an effect. Further research should examine its long-term sustainability.

The effect of universal testing and treatment on HIV stigma in 21 communities in Zambia and South Africa.

Objectives:To assess the impact of a combination HIV prevention intervention including universal testing and treatment (UTT) on HIV stigma among people living with HIV, and among community members and health workers not living with HIV.Design:This HIV stigma study was nested in the HPTN 071 (PopART) trial, a three-arm cluster randomised trial conducted between 2013 and 2018 in 21 urban/peri-urban communities (12 in Zambia and nine in South Africa).Methods:Using an adjusted two-stage cluster-level analysis, controlling for baseline imbalances, we compared multiple domains of stigma between the trial arms at 36 months. Different domains of stigma were measured among three cohorts recruited across all study communities: 4178 randomly sampled adults aged 18–44 who were living with HIV, and 3487 randomly sampled adults and 1224 health workers who did not self-report living with HIV.Results:Prevalence of any stigma reported by people living with HIV at 36 months was 20.2% in arm A, 26.1% in arm B, and 19.1% in arm C (adjusted prevalence ratio, A vs. C 1.01 95% CI 0.49–2.08, B vs. C 1.34 95% CI 0.65–2.75). There were no significant differences between arms in any other measures of stigma across all three cohorts. All measures of stigma reduced over time (0.2--4.1% reduction between rounds) with most reductions statistically significant.Conclusion:We found little evidence that UTT either increased or decreased HIV stigma measured among people living with HIV, or among community members or health workers not living with HIV. Stigma reduced over time, but slowly.ClinicalTrials.gov number:NCT01900977.