Medical Mistrust and Stigma Associated with COVID-19 Among People Living with HIV in South Africa

AIDS Behav. 2021 Dec;25(12):3967-3977. doi: 10.1007/s10461-021-03307-8. Epub 2021 May 17.


We evaluated COVID-19 stigma and medical mistrust among people living with HIV in South Africa. We conducted telephone interviews with participants in a prospective study of a decentralized antiretroviral therapy program. Scales assessing medical mistrust, conspiracy beliefs, anticipated and internalized stigma, and stereotypes specific to COVID-19 were adapted primarily from the HIV literature, with higher scores indicating more stigma or mistrust. Among 303 participants, the median stigma summary score was 4 [interquartile range (IQR) 0-8; possible range 0-24] and 6 (IQR 2-9) for mistrust (possible range 0-28). A substantial proportion of participants agreed or strongly agreed with at least one item assessing stigma (54%) or mistrust (43%). Higher COVID-19 stigma was associated with female gender and antecedent HIV stigma, and lower stigma with reporting television as a source of information on COVID-19. Further efforts should focus on effects of stigma and mistrust on protective health behaviors and vaccine hesitancy.

Keywords: COVID-19; HIV; Medical mistrust; South Africa; Stigma.

MeSH terms

  • COVID-19*
  • Female
  • HIV Infections* / drug therapy
  • Humans
  • Prospective Studies
  • SARS-CoV-2
  • South Africa / epidemiology
  • Trust