The epidemiology of HIV/AIDS stigma in low income communities of Chennai, South India
India has one of the highest numbers of HIV-infected people in the world, with an estimated 2.5 million adults and children living with HIV in 2006. The future success of HIV/AIDS prevention and care programs is critical to avert a generalized epidemic which could have devastating implications for India's health and development. HIV/AIDS stigma is reported to be a barrier to adoption of behaviors which decrease the transmission of HIV/AIDS, such as voluntary counseling and testing, adherence to antiretroviral therapy, and disclosure of HIV status to partners. Objective. This research aims to design and create quantitative measurement instruments (scales) of HIV/AIDS stigma tailored to South India, and to determine the epidemiology of HIV/AIDS stigma in low income communities of Chennai, South India. Methods. Cross-sectional studies of people living with HIV/AIDS and people at high risk of HIV infection were conducted in low income communities of Chennai. Latent variable modeling techniques such as Factor Analysis and Structural Equation Modeling were used to quantitatively measure and model HIV/AIDS stigma with multiple observed covariates. Results. Four valid and reliable scales of the different dimensions of HIV/AIDS stigma were developed. The expression and perception of HIV/AIDS stigma was found to differ by gender, education, and other behavioral factors in people not living with HIV/AIDS. Levels of self, experienced and perceived stigma reported by people living with HIV/AIDS were found to differ by gender and education, and to be associated in women with adherence to therapy and disclosure of HIV status to main partner. Conclusion. The development of quantitative scales and subsequent analysis conducted in this research can enable future research to assess the level and distribution of HIV/AIDS stigma, and to design, implement and evaluate targeted stigma reduction programs which aim to improve quality of life and reduce HIV transmission.