The impact of universal access to antiretroviral therapy on HIV stigma in Botswana

Am J Public Health. 2008 Oct;98(10):1865-71. doi: 10.2105/AJPH.2007.122044. Epub 2008 Aug 13.


Objectives: We sought to examine the impact of treatment access on HIV stigma in Botswana 3 years after the introduction of a national program of universal access to antiretroviral therapy.

Methods: We studied the prevalence and correlates of HIV stigma in a population-based study of 1268 adults in Botswana in 2004. We used multivariate logistic regression to assess correlates of stigmatizing attitudes and a new measure, anticipated HIV stigma.

Results: Overall, 38% of participants had at least 1 stigmatizing attitude: 23% would not buy food from a shopkeeper with HIV; 5% would not care for a relative with HIV. Seventy percent reported at least 1 measure of anticipated stigma: 54% anticipated ostracism after testing positive for HIV, and 31% anticipated mistreatment at work. Perceived access to antiretroviral therapy was strongly and independently associated with decreased odds of holding stigmatizing attitudes (adjusted odds ratio [AOR] = 0.42; 95% confidence interval [CI] = 0.24, 0.74) and of anticipated stigma (AOR = 0.09; 95% CI = 0.03, 0.30).

Conclusions: Our findings suggest that antiretroviral therapy access may be a factor in reducing HIV stigma. Nevertheless, the persistence of stigmatizing attitudes and significant anticipated stigma suggest that HIV stigma must be a target for ongoing intervention.

Publication types

  • Evaluation Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Attitude to Health*
  • Botswana / epidemiology
  • Cross-Sectional Studies
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • Health Knowledge, Attitudes, Practice
  • Health Services Accessibility / organization & administration*
  • Health Services Research
  • Humans
  • Logistic Models
  • Male
  • Multivariate Analysis
  • National Health Programs / organization & administration
  • Prevalence
  • Program Evaluation
  • Social Desirability
  • Stereotyping*
  • Surveys and Questionnaires
  • Universal Health Insurance / organization & administration*


  • Anti-HIV Agents