Anne Stangl

DHS adds new stigma indicators

28 April 2015
Michelle Moore

Updated stigma indicators have officially been included in the new standard Demographic and Health Surveys (DHS) questionnaires for both men and women.

STRIVE has contributed to the long path to reach this objective. Congratulations are due to Anne Stangl of ICRW-DC and her colleagues in the Stigma Action Network and other fora.

Stigma has the potential to undermine every step on the prevention-to-care continuum, as numerous studies and systematic reviews have shown. Stigma can:

  • impede or delay HIV testing
  • inhibit disclosure and linkage to care
  • undermine antiretroviral therapy (ART) adherence by compromising adaptive coping and social support, and through internalised stigma and concealment among people living with HIV

The DHS has been collecting data on stigma for several years, but the questions only assessed ‘discriminatory attitudes’. We found two of these questions to be unreliable or invalid measures of stigma while the others proved to be less useful than they were in the earlier years of the epidemic.

Anne Stangl

The updated stigma indicators in the new standard DHS questionnaire will provide data on multiple aspects of the stigmatization process. This will help national governments to target stigma-reduction interventions where they are most needed. The inclusion of the new questions is a great step forward in reducing HIV stigma.

Studying stigma within HPTN 071 (PopART)

STRIVE researchers continue to work on HIV stigma, primarily in a sub-study on stigma nested within the HPTN 071 study, also known as PopART (Population Effects of Antiretroviral Therapy to reduce HIV Transmission). This community-randomised trial in South Africa and Zambia is evaluating the impact of a universal test-and-treat intervention on community-level HIV incidence. It is one of the largest trials ever conducted.

The intervention includes a combination of prevention services, including: annual door-to-door voluntary HIV testing; immediate treatment for HIV-infected individuals regardless of CD4 count (in Arm A) and following WHO guidelines (in Arm B); and health promotion, active referral and/or retention in care support for voluntary medical male circumcision for HIV-uninfected men, prevention of mother to child transmission for HIV positive women, sexual health and TB services, and condom provision.

The study is being carried out in 21 communities (9 communities in the Western Cape of South Africa and 12 communities in Zambia) over a period of 5 years, from 2013 to 2018. A total of 2,500 individuals from each of the 21 communities will be randomly selected to form the main research cohort – the Population Cohort (N=52,500). The primary outcome is HIV incidence after 36 months, which will be measured in the Population Cohort.

Stigma can pretty much interrupt any stage along the prevention to care continuum. We want to interview everyone – including janitors, health clerks – anyone who might come into contact with patients. 

Anne Stangl, ICRW-DC, speaking on the HPTN 071 (PopART) study