1. ANALYZING SHAME AND BLAME: CORRELATES OF HIV-RELATED STIGMA IN A POPULATION-BASED SURVEY IN MALAWI
Alisha H. Creel1, Kirsten Böse3, Glory Mkandawire2, Lisa K. Folda3, Jane W. Brown3, Rajiv N. Rimal4
1 Dept of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD; 2 Malawi BRIDGE Project, Lilongwe, Malawi; 3 Johns Hopkins University Center for Communication Programs, Baltimore, MD; 4 Dept of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
HIV-related stigma
Methods
Results
Stigma is “prejudice, discounting, discrediting, and discrimination”1 against people living with HIV, their families and related groups.
Stigma harms people living with HIV and their families, and hampers prevention efforts against HIV in the general population.
Instrumental vs. symbolic stigma:
Instrumental: concern about transmission and resources.
Symbolic: norms, morals and values.
Stratified random sample of Malawi households in four districts in 2007, balanced by gender (50/50) and age (1/3 age 16-24).
In-person interviews in Chichewa or Tumbuka.
N=939
Age: mean 32.8 yrs
50.7% female
75.6% married
Education: mean 6.1 yrs
71% own a radio
Mean HIV knowledge 61%
High perceived severity
79% high condom self-efficacy and outcome expectations
41.5% have friend or family member with HIV
Univariate:
Both shame and blame:
age
education
radio ownership
HIV knowledge
friend/family with HIV
fear of casual contact
resentment
condom attitudes
perceived severity
Blame only:
married
condom outcome expectations
Shame only:
condom self-efficacy
Not significant:
Sex
Religiosity
Perceived risk
Shame and blame items
Shame items %
Agree
You would be ashamed if you were infected with HIV.
34.7
You would be ashamed if someone in your family had HIV.
29.4
People with HIV should be ashamed of themselves.
20.6
Blame items
HIV is a punishment from God.
52.9
HIV is a punishment for bad behavior.
81.9
It is women prostitutes who spread HIV in the community.
65.0
People with HIV are promiscuous.
60.5
Shame vs. blame
Multivariate:
Standardized betas from multivariate linear regression analysis of
correlates of shame and blame
Nyblade and MacQuarrie (2006)2 proposed shame and blame as two related but distinct aspects of symbolic stigma related to morality.
Measurement studies have found that these are different dimensions of stigma.3,4
Shame more impacted socially:4
Much lower in people who have a close friend or family member with HIV.
Affected by a radio diary program, but discussion reversed the effect.
Measures
Sex, age in years, years of education, marital status, religiosity, radio ownership
Knowledge of HIV
Close friend or family member with HIV
Fear of casual contact with people with HIV
Resentment toward people with HIV
Attitudes about condoms
Perceived risk for getting HIV and perceived severity of HIV
Condom self-efficacy and outcome expectations
Study Aim
To explore potential differences and similarities between shame and blame by looking at their correlates.
1. Herek, G. M., Mitnick, L., Burris, S., Chesney, M., Devine, P., Fullilove, M. T., et al. (1998). Workshop report: AIDS and stigma: a conceptual framework and research agenda. AIDS Public Policy J, 13(1),
2. Nyblade, L. C., & MacQuarrie, K. (2006). Can We Measure HIV/AIDS-Related Stigma and Discrimination?: Current Knowledge About Quantifying Stigma in Developing Countries: USAID.
3. Nyblade, L. C., MacQuarrie, K., Phillip, F., Kwesigabo, G., Mbwambo, J., Ndega, J., et al. (2005). Working Report Measuring HIV Stigma: Results of a Field Test in Tanzania. Washington, DC: Synergy.
4. Creel A. H., Böse, K., Mkandawire G., Folda L., Brown J., Rimal R. N. (2008). Effects of the Malawi BRIDGE Radio Diaries on HIV-related stigma in Malawi: An experimental design in the field. Roundtable presentation at the American Public Health Association Annual Meeting, San Diego, California, October 27, 2008.
*Statistically significant results only; models adjusted for all variables listed under Measures
Conclusions/Implications
Blame more strongly related to lack of knowledge, social distancing: reduced perceived risk despite high perceived severity, higher resentment.
More classic model of stigma.
Shame related to fear about HIV and nature of social surroundings: people with HIV among friends/family, contact with world through radio.
Strongly related to willingness to disclose.
Thanks to Salaphera Consulting.
Disclaimer: The views presented are those of the authors and not of the US Government