Jalloh Mohamed F, Kailembo Alexander, Schaad Nicolas, Nur Sophia A, Njau Prosper, Maruyama Haruka, Lavilla Kayla, Hageman Kathy, Amuri Mbaraka, Hennesy Nora, Mmari Eunice, Swaminathan Mahesh, Maboko Leonard, Mgomella George S
Division of Global HIV and TB, U.S. Centers for Disease Control and Prevention, Tanzania Office, Dar es Salaam, Tanzania.
Tanzania Ministry of Health, National AIDS Control Programme, Strategic Information Unit, Dodoma, Tanzania.
PLoS One. 2025 May 28;20(5):e0323916. doi: 10.1371/journal.pone.0323916. eCollection 2025.
Stigma is a major barrier to ending HIV as a public health threat. We present an analytical framework for quantifying the effects of HIV-related stigma on the treatment cascade using biomarker data from a Population-based HIV Impact Assessment (PHIA) in Tanzania.
We first reviewed HIV-related stigma items from 15 PHIA surveys in sub-Saharan Africa. Using nationally representative data of 1,831 diagnosed and undiagnosed PLHIV aged 15 and older in Tanzania, we applied modified Poisson regression models to examine associations of stigma with the treatment cascade, adjusting for HIV knowledge and demographics.
We identified 41 unique stigma-related items in 13 of the 15 PHIA surveys. In Tanzania, PLHIV who expressed any stigma driver (stigmatizing attitude, discriminatory attitude, or shame) were 27% less likely to know their HIV status (adjusted prevalence ratio [aPR] 0.73; 95%CI [0.65-0.83], p < 0.001), while those expressing all three were almost never aware of their status (aPR < 0.01; 95%CI [0-0.01], p < 0.001). Stigma drivers were not significantly associated with ART use among diagnosed PLHIV or viral load suppression (VLS) among those on ART. Diagnosed PLHIV who felt the need to hide their status when seeking non-HIV healthcare were 9% less likely to be on ART (aPR 0.91; 95%CI [0.85-0.98], p = 0.013), and those on ART were 10% less likely to achieve VLS (aPR 0.90; 95%CI [0.81-0.99], p = 0.047).
Stigma likely prevented many undiagnosed PLHIV in Tanzania from knowing their status. Fear of healthcare discrimination due to anticipated stigma undermines ART uptake among diagnosed PLHIV and viral suppression among those on ART. PHIA surveys have untapped potential to quantify the effects of HIV-related stigma and inform interventions to end HIV as a public health threat.
耻辱感是消除作为公共卫生威胁的艾滋病病毒的主要障碍。我们使用来自坦桑尼亚基于人群的艾滋病病毒影响评估（PHIA）的生物标志物数据，提出了一个分析框架，用于量化与艾滋病病毒相关的耻辱感对治疗流程的影响。
我们首先回顾了撒哈拉以南非洲15项PHIA调查中与艾滋病病毒相关的耻辱感项目。利用坦桑尼亚1831名15岁及以上已确诊和未确诊的艾滋病病毒感染者的全国代表性数据，我们应用修正的泊松回归模型来检验耻辱感与治疗流程之间的关联，并对艾滋病病毒知识和人口统计学因素进行了调整。
我们在15项PHIA调查中的13项中识别出41个与耻辱感相关的独特项目。在坦桑尼亚，表达任何耻辱感驱动因素（耻辱态度、歧视态度或羞耻感）的艾滋病病毒感染者知晓自己感染状况的可能性降低27%（调整患病率比[aPR]为0.73；95%置信区间[0.65 - 0.83]，p < 0.001），而表达所有三种驱动因素的感染者几乎从不了解自己的状况（aPR < 0.01；95%置信区间[0 - 0.01]，p < 0.001）。耻辱感驱动因素与已确诊的艾滋病病毒感染者使用抗逆转录病毒治疗（ART）或接受ART治疗者的病毒载量抑制（VLS）无显著关联。在寻求非艾滋病病毒医疗保健时感到需要隐瞒自己感染状况的已确诊艾滋病病毒感染者接受ART治疗的可能性降低9%（aPR为0.91；95%置信区间[0.85 - 0.98]，p = 0.013），而接受ART治疗者实现病毒载量抑制的可能性降低10%（aPR为0.90；95%置信区间[0.81 - 0.99]，p = 0.047）。
耻辱感可能使坦桑尼亚许多未确诊的艾滋病病毒感染者无法知晓自己的感染状况。由于预期的耻辱感而对医疗保健歧视的恐惧削弱了已确诊的艾滋病病毒感染者接受ART治疗的意愿以及接受ART治疗者的病毒抑制效果。PHIA调查在量化与艾滋病病毒相关的耻辱感影响并为消除作为公共卫生威胁的艾滋病病毒的干预措施提供信息方面具有尚未开发的潜力。
