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Socioeconomic Gradients in Internalized Stigma Among 4,314 Persons with HIV in Sub-Saharan Africa

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Abstract

The stigma attached to HIV is a major public health problem given its adverse impacts on HIV prevention and on the psychosocial wellbeing of persons with HIV. In this study, I apply a novel method to data from the Demographic and Health Surveys to identify persons with HIV who were aware of their seropositivity at the time of the survey. The pooled dataset includes 4,314 persons with HIV in Cameroon, Ethiopia, Gabon, Kenya, Lesotho, Malawi, Rwanda, Swaziland, Tanzania, Uganda, Zambia, and Zimbabwe. My findings indicate that nearly one-fifth of study participants provided survey responses consistent with internalization of stigmatizing beliefs. Furthermore, in multivariable regression models, striking socioeconomic gradients in internalized stigma were observed. A clear implication of my findings is that the adverse health and psychosocial impacts of HIV stigma are likely concentrated among those with the fewest socioeconomic resources for managing and resisting it.

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References

  1. Rankin WW, Brennan S, Schell E, Laviwa J, Rankin SH. The stigma of being HIV-positive in Africa. PLoS Med. 2005;2(8):e247.

    Article  PubMed Central  PubMed  Google Scholar 

  2. Pryor JB, Reeder GD, Vinacco R, Kott TL. The instrumental and symbolic functions of attitudes towards persons with AIDS. J Appl Soc Psychol. 1989;19(5):377–404.

    Article  Google Scholar 

  3. Tsai AC, Bangsberg DR, Weiser SD. Harnessing poverty alleviation to reduce the stigma of HIV in sub-Saharan Africa. PLoS Med. 2013;10(11):e1001557.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Cassens BJ. Social consequences of the acquired immunodeficiency syndrome. Ann Intern Med. 1985;103(5):768–71.

    Article  CAS  PubMed  Google Scholar 

  5. Link BG, Cullen FT, Struening E, Shrout PE. A modified labeling theory approach to mental disorders: an empirical assessment. Am Sociol Rev. 1989;54(3):400–23.

    Article  Google Scholar 

  6. Pantelic M, Shenderovich Y, Cluver L, Boyes M. Predictors of internalised HIV-related stigma: a systematic review of studies in sub-Saharan Africa. Health Psychol Rev (in press).

  7. Berger BE, Ferrans CE, Lashley FR. Measuring stigma in people with HIV: psychometric assessment of the HIV stigma scale. Res Nurs Health. 2001;24(6):518–29.

    Article  CAS  PubMed  Google Scholar 

  8. Holzemer WL, Uys LR, Chirwa ML, et al. Validation of the HIV/AIDS Stigma Instrument—PLWA (HASI-P). AIDS Care. 2007;19(8):1002–12.

    Article  PubMed  Google Scholar 

  9. Visser MJ, Kershaw T, Makin JD, Forsyth BW. Development of parallel scales to measure HIV-related stigma. AIDS Behav. 2008;12(5):759–71.

    Article  PubMed Central  PubMed  Google Scholar 

  10. Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the Internalized AIDS-Related Stigma Scale. AIDS Care. 2009;21(1):87–93.

    Article  PubMed  Google Scholar 

  11. Tsai AC, Weiser SD, Steward WT, et al. Evidence for the reliability and validity of the internalized AIDS-related stigma scale in rural Uganda. AIDS Behav. 2013;17(1):427–33.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Nyblade L, Pande R, Mathur S, et al. Disentangling HIV and AIDS stigma in Ethiopia, Tanzania, and Zambia. Washington, DC: International Center for Research on Women; 2003.

    Google Scholar 

  13. Kalichman SC, Simbayi LC, Jooste S, et al. Development of a brief scale to measure AIDS-related stigma in South Africa. AIDS Behav. 2005;9(2):135–43.

    Article  PubMed  Google Scholar 

  14. Mishra V, Agrawal P, Alva S, Gu Y, Wang S. Changes in HIV-related knowledge and behaviors in sub-Saharan Africa. DHS Comparative Reports No. 24. Calverton: ICF Macro; 2009.

  15. Genberg BL, Hlavka Z, Konda KA, et al. A comparison of HIV/AIDS-related stigma in four countries: negative attitudes and perceived acts of discrimination towards people living with HIV/AIDS. Soc Sci Med. 2009;68(12):2279–87.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Maman S, Abler L, Parker L, et al. A comparison of HIV stigma and discrimination in five international sites: the influence of care and treatment resources in high prevalence settings. Soc Sci Med. 2009;68(12):2271–8.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Pearlin LI. The sociological study of stress. J Health Soc Behav. 1989;30(3):241–56.

    Article  CAS  PubMed  Google Scholar 

  18. Link BG. Understanding labeling effects in the area of mental disorders: an assessment of the effects of expectations of rejection. Am Sociol Rev. 1987;52(1):96–112.

    Article  Google Scholar 

  19. Link BG, Mirotznik J, Cullen FT. The effectiveness of stigma coping orientations: can negative consequences of mental illness labeling be avoided? J Health Soc Behav. 1991;32(3):302–20.

    Article  CAS  PubMed  Google Scholar 

  20. Takada S, Weiser SD, Kumbakumba E, et al. The dynamic relationship between social support and HIV stigma in rural Uganda. Ann Behav Med. 2014;48(1):26–37.

    Article  PubMed  Google Scholar 

  21. Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med. 2007;64(9):1823–31.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Tsai AC, Bangsberg DR, Frongillo EA, et al. Food insecurity, depression and the modifying role of social support among people living with HIV/AIDS in rural Uganda. Soc Sci Med. 2012;74(12):2012–9.

    Article  PubMed Central  PubMed  Google Scholar 

  23. Fife BL, Wright ER. The dimensionality of stigma: a comparison of its impact on the self of persons with HIV/AIDS and cancer. J Health Soc Behav. 2000;41(1):50–67.

    Article  CAS  PubMed  Google Scholar 

  24. Govindasamy D, Ford N, Kranzer K. Risk factors, barriers and facilitators for linkage to antiretroviral therapy care: a systematic review. AIDS. 2012;26(16):2059–67.

    Article  CAS  PubMed  Google Scholar 

  25. Tsai AC. Reliability and validity of depression assessment among persons with HIV in sub-Saharan Africa: systematic review and meta-analysis. J Acquir Immune Defic Syndr. 2014;66(5):503–11.

    Article  PubMed  Google Scholar 

  26. Tsai AC, Weiser SD, Petersen ML, Ragland K, Kushel MB, Bangsberg DR. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV. Arch Gen Psychiatry. 2010;67(12):1282–90.

    Article  PubMed Central  PubMed  Google Scholar 

  27. Tsai AC, Karasic DH, Hammer GP, et al. Directly observed antidepressant medication treatment and HIV outcomes among homeless and marginally housed HIV-positive adults: a randomized controlled trial. Am J Public Health. 2013;103(2):308–15.

    Article  PubMed Central  PubMed  Google Scholar 

  28. Martinez P, Tsai AC, Muzoora C, et al. Reversal of the kynurenine pathway of tryptophan catabolism may improve depression in ART-treated HIV-infected Ugandans. J Acquir Immune Defic Syndr. 2014;65(4):456–62.

    Article  CAS  PubMed  Google Scholar 

  29. Katz IT, Ryu AE, Onuegbu AG, et al. Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis. J Int AIDS Soc. 2013;16(Suppl 2):18640.

    PubMed Central  PubMed  Google Scholar 

  30. Kinsler JJ, Wong MD, Sayles JN, Davis C, Cunningham WE. The effect of perceived stigma from a health care provider on access to care among a low-income HIV-positive population. AIDS Patient Care STDs. 2007;21(8):584–92.

    Article  PubMed  Google Scholar 

  31. Gilmore N, Somerville MA. Stigmatization, scapegoating and discrimination in sexually transmitted diseases: overcoming ‘them’ and ‘us’. Soc Sci Med. 1994;39(9):1339–58.

    Article  CAS  PubMed  Google Scholar 

  32. Bateson MC, Goldsby R. Thinking AIDS: the social response to the biological threat. Reading: Addison-Wesley; 1988.

  33. Kalusopa T, Dicks R, Osei-Boateng C, editors. Social protection schemes in Africa. African Labour Research Network: Windhoek; 2012.

    Google Scholar 

  34. Castro A, Farmer P. Understanding and addressing AIDS-related stigma: from anthropological theory to clinical practice in Haiti. Am J Public Health. 2005;95(1):53–9.

    Article  PubMed Central  PubMed  Google Scholar 

  35. Neuberg SL, Smith DM, Asther T. Why people stigmatize: toward a biocultural framework. In: Heatherton TF, Kleck RE, Hebl MR, Hull JG, editors. The social psychology of stigma. New York: The Guilford Press; 2000. p. 31–61.

    Google Scholar 

  36. Kurzban R, Leary MR. Evolutionary origins of stigmatization: the functions of social exclusion. Psychol Bull. 2001;127(2):187–208.

    Article  CAS  PubMed  Google Scholar 

  37. Portes A, Sensenbrenner J. Embeddedness and immigration: notes on the social determinants of economic action. Am J Sociol. 1993;98(6):1320–50.

    Article  Google Scholar 

  38. Niehaus I. Death before dying: understanding AIDS stigma in the South Africa lowveld. J S Afr Stud. 2007;33(4):845–60.

    Article  Google Scholar 

  39. Farmer P, Leandre F, Mukherjee JS, et al. Community-based approaches to HIV treatment in resource-poor settings. Lancet. 2001;358(9279):404–9.

    Article  CAS  PubMed  Google Scholar 

  40. Wolfe WR, Weiser SD, Leiter K, et al. The impact of universal access to antiretroviral therapy on HIV stigma in Botswana. Am J Public Health. 2008;98(10):1865–71.

    Article  PubMed Central  PubMed  Google Scholar 

  41. Maman S, van Rooyen H, Stankard P, et al. NIMH Project Accept (HPTN 043): results from in-depth interviews with a longitudinal cohort of community members. PLoS One. 2014;9(1):e87091.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Thirumurthy H, Zivin JG, Goldstein M. The economic impact of AIDS treatment: labor supply in western Kenya. J Hum Resour. 2008;43(3):511–52.

    Article  PubMed Central  PubMed  Google Scholar 

  43. Nyanzi-Wakholi B, Lara AM, Watera C, Munderi P, Gilks C, Grosskurth H. The role of HIV testing, counselling, and treatment in coping with HIV/AIDS in Uganda: a qualitative analysis. AIDS Care. 2009;21(7):903–8.

    Article  PubMed  Google Scholar 

  44. Wagner GJ, Ghosh-Dastidar B, Garnett J, Kityo C, Mugyenyi P. Impact of HIV antiretroviral therapy on depression and mental health among clients With HIV in Uganda. Psychosom Med. 2012;74(9):883–90.

    Article  CAS  PubMed  Google Scholar 

  45. Tsai AC, Bangsberg DR, Bwana M, et al. How does antiretroviral treatment attenuate the stigma of HIV? Evidence from a cohort study in rural Uganda. AIDS Behav. 2013;17(8):2725–31.

    Article  PubMed Central  PubMed  Google Scholar 

  46. Mbonye M, Nakamanya S, Birungi J, King R, Seeley J, Jaffar S. Stigma trajectories among people living with HIV (PLHIV) embarking on a life time journey with antiretroviral drugs in Jinja, Uganda. BMC Public Health. 2013;13(1):804.

    Article  PubMed Central  PubMed  Google Scholar 

  47. Venkataramani AS, Haberer JE, Thirumurthy H, et al. CD4+ cell count at antiretroviral therapy initiation and economic restoration in rural Uganda. AIDS. 2014;28(8):1221–6.

    PubMed  Google Scholar 

  48. Mishra V, Vaessen M, Boerma JT, et al. HIV testing in national population-based surveys: experience from the Demographic and Health Surveys. Bull World Health Organ. 2006;84(7):537–45.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Mishra V, Assche SB, Greener R, et al. HIV infection does not disproportionately affect the poorer in sub-Saharan Africa. AIDS. 2007;21(Suppl 7):S17–28.

    Article  PubMed  Google Scholar 

  50. UNAIDS. National AIDS programmes: a guide to monitoring and evaluation. UNAIDS/00.17E. Geneva: Joint United Nations Programme on HIV/AIDS; 2000.

  51. Burris S. Stigma, ethics and policy: a commentary on Bayer’s “Stigma and the ethics of public health: Not can we but should we”. Soc Sci Med. 2008;67(3):473–5 discussion 476–477.

    Article  PubMed  Google Scholar 

  52. Pallitto CC, O’Campo P. Community level effects of gender inequality on intimate partner violence and unintended pregnancy in Colombia: testing the feminist perspective. Soc Sci Med. 2005;60(10):2205–16.

    Article  PubMed  Google Scholar 

  53. Filmer D, Pritchett LH. Estimating wealth effects without expenditure data—or tears: an application to educational enrollments in states of India. Demography. 2001;38(1):115–32.

    CAS  PubMed  Google Scholar 

  54. Zou G. A modified poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–6.

    Article  PubMed  Google Scholar 

  55. Yelland LN, Salter AB, Ryan P. Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. Am J Epidemiol. 2011;174(8):984–92.

    Article  PubMed  Google Scholar 

  56. Williams R. Using the margins command to estimate and interpret adjusted predictions and marginal effects. Stata J. 2012;12(2):308–31.

    Google Scholar 

  57. Yebei VN, Fortenberry JD, Ayuku DO. Felt stigma among people living with HIV/AIDS in rural and urban Kenya. Afr Health Sci. 2008;8(2):97–102.

    PubMed Central  PubMed  Google Scholar 

  58. Siedner MJ, Ng CK, Bassett IV, Katz IT, Bangsberg DR, Tsai AC. Trends in CD4 count at presentation to care and treatment initiation in sub-Saharan Africa, 2002–2013: a meta-analysis. Clin Infect Dis. doi:10.1093/cid/ciu1137.

  59. Shinsasa O, Simbayi L. Nelson Mandela/HSRC study of HIV/AIDS: South African national HIV prevalence, behavioral risks and mass media, household survey 2002. Cape Town: Human Sciences Research Council; 2002.

    Google Scholar 

  60. Visser MJ, Makin JD, Vandormael A, Sikkema KJ, Forsyth BW. HIV/AIDS stigma in a South African community. AIDS Care. 2009;21(2):197–206.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Kalichman SC, Simbayi LC. HIV testing attitudes, AIDS stigma, and voluntary HIV counselling and testing in a black township in Cape Town, South Africa. Sex Transm Infect. 2003;79(6):442–7.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  62. Kalichman SC, Simbayi L. Traditional beliefs about the cause of AIDS and AIDS-related stigma in South Africa. AIDS Care. 2004;16(5):572–80.

    Article  CAS  PubMed  Google Scholar 

  63. Chan BT, Weiser SD, Boum Y, et al. Persistent HIV-related stigma in rural Uganda during a period of increasing HIV incidence despite treatment expansion. AIDS. 2015;29(1):83–90.

    Article  PubMed  Google Scholar 

  64. Mall S, Middelkoop K, Mark D, Wood R, Bekker LG. Changing patterns in HIV/AIDS stigma and uptake of voluntary counselling and testing services: the results of two consecutive community surveys conducted in the Western Cape, South Africa. AIDS Care. 2013;25(2):194–201.

    Article  PubMed  Google Scholar 

  65. Bayer R, Stuber J. Tobacco control, stigma, and public health: rethinking the relations. Am J Public Health. 2006;96(1):47–50.

    Article  PubMed Central  PubMed  Google Scholar 

  66. Stuber J, Galea S, Link BG. Smoking and the emergence of a stigmatized social status. Soc Sci Med. 2008;67(3):420–30.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Farrimond HR, Joffe H. Pollution, peril and poverty: a British study of the stigmatization of smokers. J Community Appl Social Psychol. 2006;16(6):481–91.

    Article  Google Scholar 

  68. Tsai AC, Bangsberg DR, Kegeles SM, et al. Internalized stigma, social distance, and disclosure of HIV seropositivity in rural Uganda. Ann Behav Med. 2013;46(3):285–94.

    Article  PubMed  Google Scholar 

  69. Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ. 2004;82(4):299–307.

    PubMed Central  PubMed  Google Scholar 

  70. Musheke M, Bond V, Merten S. Individual and contextual factors influencing patient attrition from antiretroviral therapy care in an urban community of Lusaka, Zambia. J Int AIDS Soc. 2012;15(Suppl 1):17366.

    PubMed Central  Google Scholar 

  71. Gourlay A, Birdthistle I, Mburu G, Iorpenda K, Wringe A. Barriers and facilitating factors to the uptake of antiretroviral drugs for prevention of mother-to-child transmission of HIV in sub-Saharan Africa: a systematic review. J Int AIDS Soc. 2013;16(1):18588.

    Article  PubMed Central  PubMed  Google Scholar 

  72. Musheke M, Ntalasha H, Gari S, et al. A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in sub-Saharan Africa. BMC Public Health. 2013;13:220.

    Article  PubMed Central  PubMed  Google Scholar 

  73. Shelton JD, Cassell MM, Adetunji J. Is poverty or wealth at the root of HIV? Lancet. 2005;366(9491):1057–8.

    Article  PubMed  Google Scholar 

  74. Lachaud JP. HIV prevalence and poverty in Africa: micro- and macro-econometric evidences applied to Burkina Faso. J Health Econ. 2007;26(3):483–504.

    Article  PubMed  Google Scholar 

  75. Msisha WM, Kapiga SH, Earls F, Subramanian SV. Socioeconomic status and HIV seroprevalence in Tanzania: a counterintuitive relationship. Int J Epidemiol. 2008;37(6):1297–303.

    Article  PubMed Central  PubMed  Google Scholar 

  76. Hargreaves JR, Glynn JR. Educational attainment and HIV-1 infection in developing countries: a systematic review. Trop Med Int Health. 2002;7(6):489–98.

    Article  PubMed  Google Scholar 

  77. Hargreaves JR, Bonell CP, Boler T, et al. Systematic review exploring time trends in the association between educational attainment and risk of HIV infection in sub-Saharan Africa. AIDS. 2008;22(3):403–14.

    Article  PubMed  Google Scholar 

  78. Hargreaves JR, Davey C, White RG. Does the ‘inverse equity hypothesis’ explain how both poverty and wealth can be associated with HIV prevalence in sub-Saharan Africa? J Epidemiol Community Health. 2013;67(6):526–9.

    Article  PubMed  Google Scholar 

  79. Hart JT. The inverse care law. Lancet. 1971;1(7696):405–12.

    Article  CAS  PubMed  Google Scholar 

  80. Victora CG, Vaughan JP, Barros FC, Silva AC, Tomasi E. Explaining trends in inequities: evidence from Brazilian child health studies. Lancet. 2000;356(9235):1093–8.

    Article  CAS  PubMed  Google Scholar 

  81. Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98(2):216–21.

    Article  PubMed Central  PubMed  Google Scholar 

  82. Link BG, Northridge ME, Phelan JC, Ganz ML. Social epidemiology and the fundamental cause concept: on the structuring of effective cancer screens by socioeconomic status. Milbank Q. 1998;76(3):375–402.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  83. de Walque D. How does the impact of an HIV/AIDS information campaign vary with educational attainment? Evidence from rural Uganda. J Dev Econ. 2007;84(2):686–714.

    Article  Google Scholar 

  84. Tsai AC. A typology of structural approaches to HIV prevention: a commentary on Roberts and Matthews. Soc Sci Med. 2012;75(9):1562–7 discussion 1568–1571.

    Article  PubMed Central  PubMed  Google Scholar 

  85. Garcia Calleja JM, Marum LH, Carcamo CP, Kaetano L, Muttunga J, Way A. Lessons learned in the conduct, validation, and interpretation of national population based HIV surveys. AIDS. 2005;19(Suppl 2):S9–17.

    Article  Google Scholar 

  86. Mishra V, Barrere B, Hong R, Khan S. Evaluation of bias in HIV seroprevalence estimates from national household surveys. Sex Transm Infect. 2008;84(Suppl 1):i63–70.

    Article  PubMed Central  PubMed  Google Scholar 

  87. Barnighausen T, Bor J, Wandira-Kazibwe S, Canning D. Correcting HIV prevalence estimates for survey nonparticipation using Heckman-type selection models. Epidemiology. 2011;22(1):27–35.

    Article  PubMed  Google Scholar 

  88. Pettifor A, MacPhail C, Suchindran S, Delany-Moretlwe S. Factors associated with HIV testing among public sector clinic attendees in Johannesburg, South Africa. AIDS Behav. 2010;14(4):913–21.

    Article  PubMed  Google Scholar 

  89. Corno L, de Walque D. Socioeconomic determinants of stigmatization and HIV testing in Lesotho. AIDS Care. 2013;25(Suppl 1):S108–13.

    Article  PubMed Central  PubMed  Google Scholar 

  90. Pitpitan EV, Kalichman SC, Eaton LA, et al. AIDS-related stigma, HIV testing, and transmission risk among patrons of informal drinking places in Cape Town, South Africa. Ann Behav Med. 2012;43(3):362–71.

    Article  PubMed Central  PubMed  Google Scholar 

  91. Reniers G, Eaton J. Refusal bias in HIV prevalence estimates from nationally representative seroprevalence surveys. AIDS. 2009;23(5):621–9.

    Article  PubMed Central  PubMed  Google Scholar 

  92. Hogan DR, Salomon JA, Canning D, Hammitt JK, Zaslavsky AM, Barnighausen T. National HIV prevalence estimates for sub-Saharan Africa: controlling selection bias with Heckman-type selection models. Sex Transm Infect. 2012;88(Suppl 2):i17–23.

    Article  PubMed Central  PubMed  Google Scholar 

  93. Katz IT, Essien T, Marinda ET, et al. Antiretroviral therapy refusal among newly diagnosed HIV-infected adults. AIDS. 2011;25(17):2177–81.

    Article  PubMed Central  PubMed  Google Scholar 

  94. de Paula A, Shapira G, Todd PE. How beliefs about HIV status affect risky behaviors: evidence from Malawi. J Appl Econom. 2014;29(6):944–64.

    Article  Google Scholar 

  95. Thornton RL. The demand for, and impact of, learning HIV status. Am Econ Rev. 2008;98(5):1829–63.

    Article  PubMed Central  PubMed  Google Scholar 

  96. Oster E, Shoulson I, Dorsey ER. Optimal expectations and limited medical testing: evidence from Huntington Disease. Am Econ Rev. 2013;103(2):804–30.

    Article  Google Scholar 

  97. Yoder PS, Nyblade L. Comprehension of questions in the Tanzania AIDS Indicator Survey. Calverton: ORC Macro; 2004.

    Google Scholar 

  98. Nyblade L, MacQuarrie K, Phillip F, et al. Measuring HIV stigma: results of a field test in Tanzania. Washington, DC: U.S. Agency for International Development; 2005.

    Google Scholar 

  99. Jones EE, Nisbett RE. The actor and the observer: divergent perceptions of the causes of behavior. In: Jones EE, Kanhouse DE, Kelley HH, Nisbett RE, Valins S, Weiner B, editors. Attribution: perceiving the causes of behavior. Morristown: General Learning Press; 1972. p. 79–94.

    Google Scholar 

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Acknowledgments

I received no specific funding for the conduct of this study. I acknowledge salary support from U.S. National Institutes of Health K23MH096620 and the Robert Wood Johnson Health and Society Scholars Program. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Correspondence to Alexander C. Tsai.

Appendix

Appendix

See Tables 3, 4, 5, 6, 7, 8.

Table 3 Demographic and Health Surveys included in this analysis
Table 4 Proportion of DHS participants who tested positive for HIV and were aware of their seropositivity, among all who were tested for HIV, by country (N = 167,002)
Table 5 Prevalence of internalized stigma, among people with HIV who were aware of their seropositivity, by country (N = 4,314)
Table 6 Socioeconomic gradients in internalized stigma, among persons with HIV who were aware of their seropositivity, using a 6-month HIV testing window (N = 3,514)
Table 7 Educational and occupational gradients in internalized stigma, among persons with HIV who were aware of their seropositivity, by country (N = 4,314)
Table 8 Economic gradients in internalized stigma, among persons with HIV who were aware of their seropositivity, by country (N = 4,314)

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Tsai, A.C. Socioeconomic Gradients in Internalized Stigma Among 4,314 Persons with HIV in Sub-Saharan Africa. AIDS Behav 19, 270–282 (2015). https://doi.org/10.1007/s10461-014-0993-7

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