The present study suggests a link between HIV testing, stigma, and social norms such that decreasing HIV-related stigma may help to increase testing. Results from a univariate logistic regression suggest that compared to those who have never tested, people who tested were significantly less likely to hold negative attitudes and beliefs about people living with HIV, more likely to believe people living with HIV/AIDS face discrimination, more likely to hold beliefs that people living with HIV/AIDS should be treated equitably, and more likely to believe that most people have previously tested for HIV. Results from a multivariate logistic regression confirm these results and show a more intricate story that these effects vary according gender and age. People with negative attitudes were significantly less likely to have received an HIV test. The interaction between perceived discrimination and age was significant indicating a stronger relationship between HIV testing and perceived discrimination for older people (compared to younger people). The significant interaction between gender and perceptions of equity indicates that women who have tested (compared to men) were more likely to feel that people who have HIV should be treated equitably. These results suggest that interventions that are designed to decrease stigma (such as by increasing HIV-related conversations, increasing rates of HIV prevention behaviors, and changing social norms around perceptions of HIV stigma) may help to increase HIV testing. Because stigma can differ by demographics and culture, interventions that are culturally and demographically tailored toward populations of interest might prove to be more effective in decreasing stigma and increasing testing.
Finding ways to increase HIV testing in South Africa may help to prevent the spread of HIV by increasing acceptance for HIV prevention behaviors and HIV treatment. 18, 23, 24
However, the high rates of stigma in South Africa might be contributing to the low rates of testing. 7, 25, 26
In the United States, Stall et al., 27
reported that two out of three men who have sex with men who were unaware of their HIV status said that HIV-related stigma affected their testing decisions. In a separate U.S. study, Herek et al., 28
found that 38% of adults would be very concerned about HIV stigma if they tested positive, and 44% said that stigma influences their testing decisions. South African studies confirm these U.S. studies. For example, South Africans who have not tested for HIV have been shown to hold more negative views about HIV. 7
Results from the 2002 South African survey indicate that 18% of respondents were unwilling to sleep in the same room with someone with HIV/AIDS, 26% were unwilling to share a meal with someone with HIV/AIDS, and 6% would not talk to someone who they knew had HIV/AIDS. 25
These stigmatizing views are significant barriers to effective HIV prevention and treatment. 5
Taken together, these studies show the importance of addressing stigma in order to increase testing rates. The present analysis suggests that South Africa is no exception; interventions that reduce HIV stigma might help to increase testing rates.
Study limitations are based on the self-report measurements used in the analysis. HIV testing was based on participant reports of previously having tested, rather than actual HIV testing behavior. However, past studies have used self-reported measures of HIV testing both in South African and internationally. 7, 29
Additionally, the stigma measures were also self-reports and it is possible that participants were motivated to underreport negative attitudes related to HIV because of social desirability biases. Finally, it is possible that reports of stigma in other countries may not be associated with HIV testing to the same extent as in South Africa. However, we believe this is unlikely as studies suggest that stigma is associated with reductions in HIV testing. 7, 25, 26
Nevertheless, addressing the association between stigma and HIV testing in South Africa is important in order to develop interventions to increase HIV testing.
The present analysis builds on the results of previous research on stigma and testing and suggests that stigma is associated with people’s HIV testing behavior in Soweto and Vulindlela, South Africa. As HIV rates in South Africa continue to climb, it becomes imperative that studies aimed to increase HIV testing and treatment in South Africa address ways to reduce stigma.