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.
References
[1]
Logie CH, James L, Tharao W, Loutfy MR (2011) HIV, Gender, Race, Sexual Orientation, and Sex Work: A Qualitative Study of Intersectional Stigma Experienced by HIV-Positive Women in Ontario, Canada. PLoS Med 8(11): doi:10.1371/journal.pmed.1001124.
[2]
Pitpitan EV, Kalichman SC, Eaton LA, Cain D, Sikkema KJ, et al. (2012) AIDS-related stigma, HIV testing, and transmission risk among patrons of informal drinking places in Cape Town, South Africa. Ann Behav Med. 43: 362–371. doi: 10.1007/s12160-012-9346-9
[3]
Abaynew Y, Deribew A, Deribe K (2011) Factors associated with late presentation to HIV/AIDS care in South Wollo Zone Ethiopia: a case-control study. AIDS Res Ther 8: 8 doi:10.1186/1742-6405-8-8.
[4]
Fanta W, Worku A (2012) Determinants for refusal of HIV testing among women attending for antenatal care in Gambella region, Ethiopia. J reprod health 9(8): 1–12. doi: 10.1186/1742-4755-9-8
[5]
Martinez J, Harper G, Carleton RA, Hosek S, Bojan K, et al. (2012) Adolescent Medicine Trials Network. The impact of stigma on medication adherence among HIV-positive adolescent and young adult females and the moderating effects of coping and satisfaction with health care. AIDS Patient Care STDs 26: 108–115. doi: 10.1089/apc.2011.0178
[6]
Vanable PA, Carey MP, Blair DC, Littlewood RA (2006) Impact of HIV-related stigma on health behaviors and psychological adjustment among HIV-positive men and women. AIDS Behav 10: 473–82. doi: 10.1007/s10461-006-9099-1
[7]
Waite K, Paasche-Orlow, Rintamaki L, Davis T, Wolf M (2007) Literacy, social stigma, and medication adherence. J Gen Intern Med 23: 1367–1372. doi: 10.1007/s11606-008-0662-5
[8]
Leta TH, Sandoy IF, Fylkesnes K (2012) Factors affecting voluntary HIV counselling and testing among men in Ethiopia: a cross-sectional survey. BMC Public Health 12: 438 doi:10.1186/1471-2458-12-438.
[9]
Turan JM, Hatcher AH, Medema-Wijnveen J, Onono M, Miller S, et al. (2012) The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods study. PLoS Med 9(8): DOI:10.1371/journal.pmed.1001295.
[10]
Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, et al. (2008) Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. AIDS 22: doi:10.1097/01.aids.0000327438.13291.62.
[11]
Parker R, Aggleton P (2002) HIV/AIDS stigma and discrimination: A conceptual framework and basis for action. Geneva, Switzerland: Joint United Nations Programme on HIV/AIDS. The Population council Inc.
[12]
Genberg BL, Kawichai S, Chingono A, Sendah M, Chariyalertsak S, et al. (2008) Assessing HIV/AIDS stigma and discrimination in developing countries. AIDS Behav. 12: 772–780. doi: 10.1007/s10461-007-9340-6
[13]
Herek GM, Mitnick L, Burris S, Chesney M, Devine P, et al. (1998) AIDS and stigma: a conceptual framework and research agenda. AIDS Public Policy J. 13: 36–47.
[14]
Kalichman SC, Simbayi LC, Jooste S, Toefy Y, Cain D, et al. (2005) Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav 9: 135–43. doi: 10.1007/s10461-005-3895-x
[15]
Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, et al. (2009) Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale. AIDS Care 21: 87–93. doi: 10.1080/09540120802032627
[16]
Parker P, Aggleton P (2003) HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action. Soc Sci Med 57: 13–24. doi: 10.1016/s0277-9536(02)00304-0
[17]
Brown L, Macintyre K, Trujillo L (2003) Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Educ Prev 15: 49–69. doi: 10.1521/aeap.15.1.49.23844
[18]
UNAIDS (2007) Reducing HIV stigma and discrimination: a critical part of national AIDS programmes. Geneva: UNAIDS.
[19]
UNAIDS (2010) 26th meeting of the UNAIDS programme coordinating board.
Stein J (2003) HIV/AIDS stigma: The latest dirty secret. Afr J AIDS Res 2(2): 95–101. doi: 10.2989/16085906.2003.9626564
[22]
Goffman E (1963) Stigma: Notes on the management of spoiled identity. Garden City, NY: Anchor Books.
[23]
Klienman A, Hall-Clifford R (2009) Stigma: A Social, Cultural and Moral Process. J Epidemiol Community Health 63(6): 418–19. doi: 10.1136/jech.2008.084277
[24]
Smolak A, El-Bassel N (2013) Multilevel Stigma as a Barrier to HIV Testing in Central Asia: A Context Quantified. AIDS Behav 17: DOI 10.1007/s10461-013-0571-4.
[25]
Stephenson R (2009) Community factors shaping HIV-related stigma among young people in three African countries. AIDS Care 21(4): 403–410. doi: 10.1080/09540120802290365
[26]
Chen J, Choe MK, Chen S, Zhang S (2005) Community environment and HIV/AIDS-related stigma in China. AIDS Educ Prev 17(1): 1–11. doi: 10.1521/aeap.17.1.1.58689
[27]
Malcolm A, Aggleton P, Bronfman M, Galv？o J, Mane P, et al. (1998) HIV-related stigmatization and discrimination: Its forms and contexts. Crit Public Health 8(4): 347–370. doi: 10.1080/09581599808402920
[28]
Kalichman SC, Simbayi L (2004) Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa. AIDS Care 16(5): 572–580. doi: 10.1080/09540120410001716360
[29]
Lifson AR, Demissie W, Tadesse A, Ketema K, May R, et al. (2012) HIV/AIDS stigma-associated attitudes in a rural Ethiopian community: characteristics, correlation with HIV knowledge and other factors, and implications for community intervention. BMC Int Health Human Rights 12(6): doi:10.1186/1472-698X-12-6.
[30]
Pulerwitz J, Michaelis A, Weiss E, Brown L, Mahendra V (2010) Reducing HIV-related stigma: lessons learned from Horizons Research and Programs. Public Health Rep 125: 272–281.
[31]
Creel AH, Rimal RN, Mkandawire G, Bose K, Brown JW (2011) Effects of a mass media intervention on HIV-related stigma: Radio Diaries Program in Malawi. Health Educ Res 26(3): 456–465. doi: 10.1093/her/cyr012
[32]
Fakolade R, Adebayo SB, Anyanti J, Ankoman A (2010) The impact of exposure to mass media campaigns and social support on levels and trends of HIV-related stigma and discrimination in Nigeria: tools for enhancing HIV prevention programmes. J Biosoc Sci 42: 395–407. doi: 10.1017/s0021932009990538
[33]
Li L, Rotheram-Borus MJ, Yao L, Zunyou W, Chunqing L, et al. (2009) Mass Media and HIV/AIDS in China. J Health Commun 14(5): 424–438. doi: 10.1080/10810730903032994
[34]
Yebei VN, Fortenberry JD, Ayuku DO (2008) Felt stigma among people living with HIV/AIDS in rural and urban Kenya. Afr Health Sci 8(2): 97–102.
[35]
Kalichman SC, Simbayi L (2003) HIV testing attitudes, AIDS stigma, and Voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sex Transm Infect 79: 442–447. doi: 10.1136/sti.79.6.442
[36]
Bertrand JT, Anhang R (2006) The effectiveness of mass media in changing HIV/AIDS-related behaviour among young people in developing countries. World Health Org Tech Rep Series 938: 205–41.
[37]
Bekalu MA, Eggermont S (2013) Media use and HIV/AIDS knowledge: a knowledge gap perspective. Health Promot Int DOI:10.1093/heapro/dat030.
[38]
Viswanath K, Ackerson LK (2011) Race, Ethnicity, Language, Social Class, and Health Communication Inequalities: A Nationally-Representative Cross-Sectional Study. Plos One, 6, e14550 doi:14510.11371/journal.pone.0014550.
[39]
Viswanath K, Ramanadhan S, Kontos EZ (2007) Mass Media. In S. Galea (Ed.), Macrosocial Determinants of Population Health New York: Springer.
[40]
Viswanath K, Emmons KM (2006) Message effects and social determinants of health: Its application to cancer disparities. J Comm 56: 238–264. doi: 10.1111/j.1460-2466.2006.00292.x
[41]
Jung J, Arya M, Viswanath K (2013) Effect of Media Use on HIV/AIDS-Related Knowledge and Condom Use in Sub-Saharan Africa: A Cross-Sectional Study. PLOS ONE, 8(7) DOI:10.1371/journal.pone.0068359.
[42]
Herek GM, Capitanio JP, Widaman KF (2002) HIV-Related Stigma and Knowledge in the United States: Prevalence and Trends, 1991–1999. Am J Public Health 92(3): 371–377. doi: 10.2105/ajph.92.3.371
[43]
UNAIDS (2009) AIDS Epidemic Update. Geneva: UNAIDS.
[44]
MEASURE DHS, Overview available: http://www.measuredhs.com/What-We-Do/Sur？vey-Types/DHS.cfm.Accessed 2013 Nov 18.
[45]
Adetunji JA, Shelton JD (2011) Ethical Issues in the Collection, Analysis and Dissemination of DHS Data in sub-Saharan Africa. Sixth African Population Conference. Ouagadougou, Burkina Faso, 5–9 December 2011.
[46]
UNAIDS (2011) Epidemic update and health sector progress towards Universal Access. Geneva: UNAIDS.
[47]
Schulz AJ, Mullings L (2006) Gender, race, class and health: Intersectional approaches. San Francisco: Jossey-Bass.
[48]
Williams DR, Kontos EZ, Viswanath K, Haas JS, Lathan C, et al. (2012) Integrating multiple social statuses in health disparities research: the case of lung cancer. Health Serv Res 47: 1255–77. doi: 10.1111/j.1475-6773.2012.01404.x
[49]
Gerbner G, Gross L, Morgan M, Signorielli N (1980) The mainstreaming of America: Violence profile no. 11. J Comm 30: 10–29. doi: 10.1111/j.1460-2466.1980.tb01987.x
[50]
Collins CB, Hearn KD, Whittier DN, Freeman A, Stallworth JD, et al. (2010) Implementing packaged HIV-prevention interventions for HIV-positive individuals: considerations for clinic-based and community-based interventions. Pubic Health Rep 125: 55–63.
[51]
Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S (2013) A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? Journal of the International AIDS Society 16 (Suppl 2): 18734. doi: 10.7448/ias.16.3.18734
[52]
Hendriksen ES, Hlubinka D, Chariyalertsak S, Chingono A, Gray G, et al. (2009) Keep Talking About It: HIV/AIDS-Related Communication and Prior HIV Testing in Tanzania, Zimbabwe, South Africa, and Thailand. AIDS Beh 13: 1213–1221. doi: 10.1007/s10461-009-9608-0
[53]
Nyamwaya D, Nordberg E, Oduol E (1998) Socio-Cultural Information in Support of Local Health Planning: Conclusions from a Survey in Rural Kenya. Int J Health Plan Mgt 13: 27–45. doi: 10.1002/(sici)1099-1751(199801/03)13:1<27::aid-hpm498>3.0.co;2-b
[54]
Muturi NW (2005) Communication for HIV/AIDS Prevention in Kenya: Social-Cultural Considerations. J Health Comm 10: 77–98. doi: 10.1080/10810730590904607
