The effects of home-based HIV counseling and testing on HIV/AIDS stigma among individuals and community leaders in western Kenya: Evidence from a cluster-randomized trial

Abstract

HIV counseling and testing services² play an important role in HIV treatment and prevention efforts in developing countries. Community-wide testing campaigns to detect HIV earlier may additionally impact community knowledge and beliefs about HIV. We conducted a cluster-randomized evaluation of a home-based HIV testing campaign in western Kenya and evaluated the effects of the campaign on community leaders’ and members’ stigma toward people living with HIV/AIDS. We find that this type of large-scale HIV testing can be implemented successfully in the presence of stigma, perhaps due to its “whole community” approach. The home-based HIV testing intervention resulted in community leaders reporting lower levels of stigma. However, stigma among community members reacted in mixed ways, and there is little evidence that the program affected beliefs about HIV prevalence and prevention.

Keywords:

• HIV/AIDS
• stigma
• HIV testing
• community
• randomized trial

Notes

1. This article was prepared as part of the Evaluation of the Community Response to HIV and AIDS led by the World Bank, and supported through the World Bank and DfID. The views contained here in no way represent the views of the World Bank or its member countries.

2. The program studied here has been supported by the President's Emergency Plan for AIDS Relief (PEPFAR) through USAID under the terms of Cooperative Agreement No. 623-A-00-08-00003-00.

3. AMPATH is a partnership between Moi University School of Medicine, Moi Teaching and Referral Hospital, and a consortium of US medical schools led by Indiana University. This group operates clinics and provides HIV testing and treatment as well as other health services throughout western Kenya.

4. Randomization was done by listing all communities, matching them into pairs (and in one case a triple) within divisions based on household demographics and then assigning the initial group to receive HBCT using Stata version 10.0 (StataCorp).

5. Random sampling performed using Stata version 10.0 (StataCorp).

6. There was some non-response due to the lag between the census and surveying, resulting in households being unavailable. For example, in Burnt Forest, 1394 households were initially selected from the census and we completed 1071 surveys at a response rate of 77%.

7. To avoid confusion, we recoded the survey questions so that a higher number always means more. This means that in the condom use questions, which are on a scale of 1–4, a higher number means more importance placed on condom use. For our stigma questions, which are on a scale of 1–5, a higher number always means more stigma.

8. The final completion is lower than the target number due to some community leaders being unavailable during the survey period.

9. Our survey question did not define immoral behavior, but in Kenya the widely understood interpretation is infidelity. A minority of people may also interpret this as referring to intravenous drug use, or even witchcraft.

10. For examples of such interventions, see (Brown, Macintyre, & Trujillo, 2003).

11. Questions 16 and 17 were not included in the indices because they are not highly correlated with other answers, and may have been confusing to respondents.