Experiences of HIV-related stigma among HIV-positive older persons in Uganda – a mixed methods analysis

Figures & data

Table 1. Background characteristics of respondents (n = 182), for quantitative assessment.

Characteristic	Group	No. of HIV on ART (%)	No. of HIV not on ART (%)	Total
		(n = 94)	(n = 88)	(n = 182)
Sex	Male	40 (42.6)	34 (38.6)	74
	Female	54 (57.5)	54 (61.4)	108
Age	50–59	53 (56.4)	55 (62.5)	108
	60–69	31 (33)	18 (20.5)	49
	70+	10 (10.6)	15 (17.1)	25
Residence	Rural	46 (49)	40 (45.5)	86
	Urban	48 (51.1)	48 (54.6)	96
Education level	None	14 (14.9)	21 (24.1)	35
	Primary	56 (59.6)	49 (56.3)	105
	Secondary	21 (22.3)	14 (16.1)	35
	Higher	3 (3.2)	3 (3.5)	6
Current marital status	Never married	1 (1.1)	1 (1.1)	2
	Married/cohabiting	23 (24.5)	27 (30.7)	50
	Divorced/separated	17 (18.1)	22 (25)	39
	Widowed	53 (56.4)	38 (43.2)	91
Permanent income quintile	lowest	17 (18.1)	21 (23.9)	38
	Second	17 (18.1)	21 (23.9)	38
	Middle	20 (21.3)	19 (21.6)	39
	Fourth	21 (22.3)	16 (18.2)	37
	Highest	19 (20.2)	11 (12.5)	30

Table 2. Frequency distribution of responses to the five questions on disclosure and stigma among 182 HIV-positive respondents aged 50 and over.

	Never	Seldom	Sometimes	Often	Very often	Total
Disclosure of HIV-positive status to others	9.3	4.4	20.3	19.8	46.2	100.0
Avoid disclosure of HIV status outside family	66.0	4.3	7.5	10.6	11.7	100.0
Been in situations where others say unfavourable things about people with HIV	26.9	9.3	19.8	22.5	21.4	100.0
Worried about others viewing them unfavourably because I am HIV positive	59.3	11.0	8.2	8.2	13.2	100.0
Feels treated as less competent because of HIV positive	63.7	6.6	12.6	7.1	9.9	100.0

Table 3. Disclosure and stigma scores by respondent characteristics.

		Disclosure score		Stigma score
	Number	%	SE	%	SE
All	182	54.9	3.7	46.7	1.8
Women	108	50.0	4.8	48.6	2.4
Men	74	62.2	5.7	43.8	2.9
On ART	94	60.6	5.1	49.0	2.6
Not on ART	88	48.9	5.4	44.2	2.6
Rural	86	52.3	5.4	47.4	2.7
Urban	96	57.3	5.1	46.0	2.5
Poorest 40%	76	53.9	5.8	43.7	2.7
Top 60%	106	55.7	4.8	48.8	2.5
No education	35	45.7	8.5	48.2	4.4
Primary	88	60.2	5.2	46.4	2.6
Secondary +	54	53.7	6.8	46.3	3.3
Disclosure high	82			47.4	2.7
Disclosure low	100			46.1	2.5

Note: SE, standard error.

Table 4. Background characteristics of respondents (n = 25) for qualitative assessment.

Sex	Male	12
	Female	13
Age	80>	1
	70–79	13
	60–69	11
Location	Kalungu	5
	Wakiso	20
ART	On ART	18
	Not on ART	7
HIV care centre	MRC/UVRI	5
	TASO	20
Tribe	Ethnic Baganda	13
	Rwandese/Burundian origin	7
	Others	5
Marital status	Married	7
	Widowed	12
	Separated/divorced	6
	Other^a	0
Living	Lived alone	8
	Lived with grandchildren/other relatives	17

^aCohabiting, never married.

Table 5. A summary of stigma-related comments extracted from Grace's (female, 73) oral monthly diary.

Month	Attitude to HIV/AIDS and stigma
1	Grace said that people with HIV/AIDS should not fear to join TASO ‘to help them kill the stigma’
7	She said she feels out of place at social gatherings (parties, weddings, religious events) because she thinks of her condition ‘every now and then’. However, this is perhaps more of a preoccupying health anxiety than HIV/AIDS-related self-stigma
10	She described herself as a very social person, known and treated well in her community. She proudly said that this is why the neighbours directed the interviewer to her that day without hesitation. When she attends ceremonies (i.e. funerals) she asks for food and meat to take home; she no longer feels ashamed to carry food home. However, In one of the interview transcripts, the interviewer commented that Grace is a ‘cruel old lady whose moods change from time to time, so counselling has been on and off to maintain our discussion flow’
11	She said that unless there is a problem or a function to attend, she does not associate much with village members because they gossip a lot. The interviewer commented that the respondent ‘fears being laughed at’. The subject and tone of the anticipated gossip were not stated in the interview transcript, the interviewer noted that Grace ‘fears being laughed at’ although, the interviewer added, there is ‘less stigma now than there used to be’. The respondent proudly declared that she is an HIV/AIDS ‘consultant’ in her village; she advises people to go to TASO for HIV tests. However, gossip does not necessarily have malicious intent; it is not necessarily discrimination or enacted stigma, and a wish to avoid gossip is not necessarily driven by fear
12	Grace was more defiant with regards to gossip, and typically defiant with regards to stigma. Grace said she ‘has no stigma’ and that even if she went to a function she would ‘not care’ because ‘the whole world is infected with HIV/AIDS’. During the twelfth monthly interview, commenting that she ‘has no stigma’ and that even if she went to a function she would ‘not care’ because ‘the whole world is infected with HIV/AIDS’. In this way, Grace seemingly takes a determined attitude towards stigma, seeing it as something that should be fought against, that her HIV status presents a choice of acceptance or denial: that although HIV/AIDS is prevalent, stigma does not need to be
	This confidence stretches beyond HIV/AIDS-related stigma, perhaps to encompass poverty-related stigma: Grace said her appetite is good and when she attends ceremonies (i.e. funerals) she eats a lot and asks for food and meat to take home. Whereas she used to feel ashamed to carry food home, now she does not mind