HIV-related stigma and its association with HIV transmission risk behaviors among motorcyclists in Mbarara Municipality, southwestern Uganda.

Key populations have a disproportionate burden of HIV compared with the general population. HIV-related stigma has been recognized as a major barrier to HIV prevention and treatment efforts. It remains unclear whether HIV-related stigma is a significant driver of HIV transmission risk behavior among (motorcycle taxi) riders, a key population in Uganda. We conducted a cross-sectional study among motorcyclists in Mbarara Municipality of southwestern Uganda. Using multistage sampling, we recruited participants aged 18-59 years who had been riding for at least 6 months. The primary explanatory variable of interest was HIV-related stigma, measured using the 7-item STRIVE scale and dichotomized at "no stigma" versus "any stigma." Self-reported HIV transmission risk behaviors included: condomless sexual intercourse, sexual intercourse under the influence of alcohol, having non-primary sexual partners, and sexual intercourse with a commercial sex worker. We used multivariable logistic regression to estimate the association between HIV-related stigma and HIV transmission risk behavior. We enrolled 401 motorcyclists. All were men. Most [330 (82%)] were classified as having HIV-related stigma, particularly among younger men aged 18-29 years. One hundred and thirty-two (34%) participants reported their last sexual encounter was with a non-primary partner, 153 (39%) did not know the serostatus of their last sexual partner, and 138 (36%) reported sexual intercourse with a sex worker in the past 6 months. In multivariable logistic regression, HIV-related stigma (adjusted odds ratio [aOR] = 1.88, 95% CI: 1.06-3.34) had a statistically significant association with any HIV transmission risk behavior. Men who reported either minimal alcohol use (aOR = 1.81, 95% CI: 1.07-2.95) or harmful alcohol use (aOR = 3.5, 95% CI: 1.92-6.54), compared with men who reported no alcohol use, also reported greater odds of HIV transmission risk behavior. HIV transmission risk behavior is common among motorcyclists in the municipality and is associated with both HIV-related stigma and alcohol use. Interventions aimed at reducing HIV-related stigma and alcohol use may potentially reduce the high rates of HIV transmission risk behavior in this key population.