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Does HIV stigma influence how people see their own HIV risk?

Hester Phillips

15 February 2023

Young women in South Africa who see HIV as a punishment for promiscuity are less likely to see themselves as being at risk, new study suggests 

young woman walking down street on her phone
Photos are used for illustrative purposes. They do not imply health status or behaviour. Credit: iStock/Ridofranz

A study among young women in South Africa suggests that people’s sense of their own HIV risk is influenced by whether they see HIV in a stigmatising way.

What is the research about?

HIV stigma and whether this affects people’s sense of how at risk they are of getting HIV. Researchers also looked at whether people’s sense of their own HIV risk affects key behaviours, such as whether they use condoms.

For the study, researchers assessed survey data from 384 young women (ages 17–25) from Cape Town in South Africa.

Why is this research important?

Risk perception is central to health behaviour change strategies. The theory goes that, if someone is at risk of getting HIV, the first step to them adopting safer behaviours is them actually recognising that they are at risk.

What did they find out?

Most participants either saw themselves as being at no risk of getting HIV (42.5%) or being at a small risk (34.1%).

But many participants were having condomless sex. Around 60% reported having one sexual partner in the last 12 months, and half had not used a condom the last time they had sex. Thirty-nine participants reported having more than one sexual partner in the last 12 months. Of these, 23 had not used a condom the last time they had sex.

Stigmatising attitudes towards HIV were common. Around 40% thought that HIV is a punishment for sleeping around. Just over half (52%) thought that people with HIV only have themselves to blame. Participants with these stigmatising views were more likely to see themselves as being at low risk of HIV than those who did not hold these views.

Researchers expected to find a link between people seeing themselves as being at high risk of HIV and practicing safer sex. But this was not the case, as participants who saw themselves as high risk were more likely to have unsafe sex. The study did not look at participants’ future intentions, rather it looked at their previous behaviours. So one possible explanation for this result is that participants had already engaged in risky sexual behaviour which is why they classified themselves as being at high risk of HIV.

What does this mean for HIV services?

The study suggests that having stigmatising attitudes towards HIV can influence people’s judgement about their own vulnerability to HIV. People with stigmatising attitudes might not see themselves as being at risk of HIV when in fact they might be. This is troubling as it means that some people might take more sexual risks than they would if they had a more accurate sense of their HIV risk.

If you are working on HIV prevention, understanding people’s attitudes towards HIV and their sense of personal HIV risk could make a real difference. Discussing these things could help people gain a better sense of their HIV risk, which might influence their behaviour.

One strategy to support young women at high risk of HIV, whether they see themselves in this way or not, is to work with peer educators. Peer educators can discuss HIV-related stigma, provide accurate information about HIV risk and support young women to access HIV testing and prevention services (such as PrEP and condoms).

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