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4.6: STIGMA AND UPTAKE OF HIV TESTING
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After scoring, the proportion of respondents classified as having a high (score>5) or low (score<5) tendency to stigmatize was as shown in the graph below:
Figure 4.10: Stigmatizing Attitudes: Proportion of Respondents (%)
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The scores for stigmatizing attitudes between men and women were compared and are as shown below:
Table 4.17: Stigmatizing Attitudes by Gender
Gender
Stigmatizing attitude
Low High Total
Men
163(40.4%) 107(39.6%) 270(100%)
Women 204(62.6%) 122(37.4%) 326(100%)
Total 367 (61.6%) 229(38.4%) 596(100%)
There was no statistically significant difference in stigmatizing attitudes between men and women (x2= 0.304 df = 1 p= 0.581)
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Stigmatizing attitudes and uptake of HIV testing
Uptake of HIV testing was compared to stigmatizing tendencies and the result was as shown in the table below:
Table 4.18: Stigmatizing Attitudes and HIV Testing.
Stigmatizing tendencies
History of HIV testing
Total
Tested Not tested
Low 161(43.9%) 206(56.1%) 367(100%)
High 65(28.4%) 164(71.6%) 229(100%)
Total 226(37.9%) 370(62.1%) 596(100%)
There was a strong significant difference in uptake of HIV testing between those who had a high tendency to stigmatize and those who had a low tendency. (x2 = 11.363 df = 1 p=0.000) .The crude odds ratio was calculated to be 1.972 ( CI= 1.385-2.808)
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The results were stratified by knowledge to determine if level of knowledge was a confounder as shown in the table below;
Table 4.19: Knowledge, Stigmatizing Tendencies and Uptake of HIV Testing.
Stigmatizing tendencies
Good knowledge Poor knowledge
Tested Not tested Total Tested Not tested
Total
Low 160(45.2%) 194(54.8%) 354(100%) 1(7.7%) 12(92.3%) 13(100%)
High 63(29.7%) 194(70.3%) 212(100%) 2(1.8%) 15(88.2%) 17(100%)
Total 223(39.4%) 343(60.6%) 566(100%) 3(10.0%) 27(90.0%) 30(100%)
A Mantel-Haenszel adjusted odds ratio was calculated and found to be 1.903 (CI 1.332 – 2.719).
The percentage difference between the crude (1.972) and adjusted odds ratio was calculated and found to be less than 10% (1.972-1.903/1.972 x 100 = 3.5 %.) thus knowledge had no significant confounding effect.
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Gender, stigma and HIV testing
The results where stratified by gender. The table below shows the relationship between stigmatizing attitudes in men and uptake of HIV testing
Table 4.20: Stigmatizing Attitudes and Uptake of HIV Testing (Men)
Stigmatizing attitudes
History of HIV testing
Tested Not tested Total
Low 63(38.7%) 100(61.3%) 163(100%)
High 28 (26.2%) 79(73.8%) 107(100%)
Total 91(33.7%) 179(66.3%) 270(100%)
A greater proportion of men with high tendency to stigmatize had not tested compared to those who had low tendencies and this difference was significant (x2 = 4.504 df = 1 p=0.034). The odds of not testing with high a tendency to stigmatize were 1.78 (CI 1.042 – 3.032)
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The relationship between stigmatizing attitudes in women and uptake of HIV testing is shown in the table below:
Table 4.21: Stigmatizing Attitudes and Uptake of HIV Testing (Women)
Stigmatizing attitudes
History of HIV testing
Tested Not tested Total
Low 98(48.0%) 106(52.0%) 204(100%)
High 37(30.3%) 85 (69.7%) 122(100%)
Total 135(41.4%) 191(58.6%) 326(100%)
A greater proportion of women with high tendency to stigmatize had not tested compared to those who had low tendencies and this difference was significant (x2 = 9.87 df = 1 p=0.002). The odds of not testing with a high tendency to stigmatize was 2.124 (CI 1.322 – 3.411).
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Observed Enacted Stigma
Only 6% of respondents had observed positive persons being stigmatized in their community. The percentage positive response for the different form of stigma observed is as shown in the table below:
Table 4.22: Percentage Response: Forms of Enacted Stigma Observed
Type of stigma
% Response
Yes No No
Response Ever seen HIV infected person excluded from social
gathering? 2 92.4 5.6
Ever seen HIV infected person denied healthcare services in the last 12 months?
93.3 1.2 5.5
Ever seen HIV infected person verbally abused in the last 12 months?
6 93.8 0.2
Ever seen HIV infected person abandoned by partner or family?
3 91.4 5.6
Ever seen HIV infected person died of AIDS 22.3 71.1 6.6
The commonest form of stigma observed was discrimination in access to health care.
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After scoring, (score >5 high awareness and <5 low awareness), the proportion of women that were aware of stigma was greater than men but this was not statistically significant (x2= 2.22 df = 1 p=
0.137). The distribution of men and women in the two categories for observed enacted stigma were as shown in the chart below:
Figure 4.11: Enacted Stigma in Men and Women
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Observed enacted stigma and HIV testing
Level of observed enacted stigma was compared to uptake of HIV testing as shown in the table below:
Table 4.23: Observed Enacted Stigma and Uptake of HIV Testing
Observed enacted stigma score
History of HIV testing
Total Tested Not tested
Low 211(37.7%) 349(62.3%) 560(100%)
High 15(41.7%) 21(58.3%) 36(100%)
Total 226(37.9%) 370(62.1%) 596(100%)
There was no statistically significant difference between the level of observed enacted stigma and uptake of HIV testing (x2= 2.22 df = 1 p= 0.137).
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The result was stratified by gender. The tables below shows observed enacted stigma and uptake of HIV testing in men:
Table 4.24: Observed Enacted Stigma and Uptake of HIV Testing (Men)
Observed enacted stigma score
History of HIV testing
Tested Not tested Total
Low 87 (33.7%) 171(66.3%) 258(100%)
High 4(33.3%) 8 (66.7%) 12(100%)
Total 91(33.7%) 179(66.3%) 270(100%)
There was no statistically significant difference between the level of observed enacted stigma and uptake of HIV testing in men (x2= 0.001 df = 1 p= 0.978).
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The table below shows observed enacted stigma and uptake of HIV testing in women:
Table 4.25: Observed enacted stigma and uptake of HIV testing (Women)
Observed enacted stigma
History of HIV testing
Tested Not tested Total
Low 124(41.1%) 178(58.9%) 302(100%)
High 11 (45.8%) 13(54.2%) 24(100%)
Total 135(41.4%) 191(58.6%) 326(100%)
There was no statistically significant difference between the level of observed enacted stigma and uptake of HIV testing in women(x2= 0.209 df = 1 p= 1.00).
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4.7: CHOICE OF CARE-PROVIDER FOR MANAGEMENT OF STI AND HIV TESTING