Effect of a multicomponent behavioural PMTCT cluster randomised controlled trial on HIV stigma reduction among perinatal HIV positive women in Mpumalanga province, South Africa

Figures & data

Table 1. Relationships with Stigma Experience Among HIV Positive Women (N = 683).

	Groups			Z/t/χ^2, p
Characteristic	All (n = 683) n(%) Mean(SD)	Non-Stigma (n = 517) n(%) Mean(SD)	Stigma (n = 166) n(%) Mean(SD)
Sociodemographic
Age	28.41 (5.78)	28.11 (0.25)	29.32 (0.48)	−2.23, 0.026^a
Educational attainment
0–10 years	149 (21.8%)	108 (20.9%)	41 (24.7%)	1.58, 0.454
10–11 years	340 (49.8%)	257 (49.7%)	83 (50.0%)
12 years or more	194 (28.4%)	152 (29.4%)	42 (25.3%)
Employment status
Unemployed	533 (78.0%)	401 (77.6%)	132 (79.5%)	0.28, 0.869
Employed	119 (17.4%)	92 (17.8%)	27 (16.3%)
Volunteering or Student	31 (4.5%)	24 (4.6%)	7 (4.2%)
Monthly household income (South African Rand)
<310 (∼ $25)	225 (32.9%)	175 (33.8%)	50 (30.1%)	1.55, 0.462
310–949 (∼ $76)	233 (34.1%)	170 (32.9%)	63 (38.0%)
950 or more	225 (32.9%)	172 (33.3%)	53 (31.9%)
Marital status
Not married, living separate	405 (59.3%)	306 (59.2%)	99 (59.6%)	1.20, 0.550
Not married, living together	153 (22.4%)	120 (23.2%)	33 (19.9%)
Married	125 (18.3%)	91 (17.6%)	34 (20.5%)
Alcohol use of 1 or more drinks at least once in the past 4 weeks
No	589 (86.2%)	454 (87.8%)	135 (81.3%)	4.46, 0.035
Yes	94 (13.8%)	63 (12.2%)	31 (18.7%)
Pregnancy unplanned
No	322 (47.1%)	243 (47.0%)	79 (47.6%)	0.02, 0.895
Yes	361 (52.9%)	274 (53.0%)	87 (52.4%)
Weeks pregnant	17.81 (5.68)	18.13 (5.69)	16.80 (5.53)	−2.46, 0.014^a
Adherence	6.02 (2.00)	6.82 (1.86)	5.83 (2.18)	−1.44, 0.151^a
Depression (EDS Score)
EDS Score is 0–12	349 (51.1%)	282 (54.5%)	67 (40.4%)	10.12, 0.001
EDS Score is 13 or greater	334 (48.9%)	235 (45.5%)	99 (59.6%)
HIV Related Variable
Diagnosed during this pregnancy
No	314 (46.0%)	239 (46.2%)	75 (45.2%)
Yes	369 (54.0%)	278 (53.8%)	91 (54.8%)	0.06, 0.814
HIV serostatus of children
Do not know	513 (94.6%)	386 (95.1%)	127 (93.4%)	0.58, 0.448
Positive	29 (5.4%)	20 (4.9%)	9 (6.6%)
Children currently on ART
No	2 (6.9%)	1 (4.5%)	1 (14.3%)	FET, 0.79, 0.431
Yes	27 (93.1%)	21 (95.5%)	6 (85.7%)
Disclosure of serostatus (to anyone)
No	188 (27.5%)	134 (25.9%)	54 (32.5%)	2.75, 0.097
Yes	495 (72.5%)	383 (74.1%)	112 (67.5%)
Months since HIV diagnosis	23.45 (36.99)	23.02 (35.72)	24.78 (40.77)	−0.40, 0.688^a
Months since ART initiation	13.24 (24.32)	12.89 (24.19)	14.31 (24.77)	−0.55, 0.586^a
HIV Knowledge	13.76 (3.20)	14.06 (3.16)	13.33 (3.22)	−3.16, 0.002^a
Partner Variable
Disclosure of serostatus (to partner)
No	93 (18.8%)	63 (16.4%)	30 (26.8%)	6.07, 0.014
Yes	402 (81.2%)	320 (83.6%)	82 (73.2%)
HIV serostatus of spouse/partner
Negative/Do not know	97 (36.2%)	83 (38.2%)	14 (27.5%)	2.09, 0.149
Positive	171 (63.8%)	134 (61.8%)	37 (72.5%)
Partner currently on ART
No/Unknown	71 (41.5%)	55 (41.0%)	16 (43.2%)	0.06, 0.810
Yes	100 (58.5%)	79 (59.0%)	21 (56.8%)
Intimate Partner Violence
No mild / Severe physical violence	547 (80.1%)	423 (81.8%)	124 (74.7%)	3.99, 0.046
Mild or severe physical violence	136 (19.9%)	94 (18.2%)	42 (25.3%)
Psychological Intimate Partner Violence	3.23 (5.31)	3.02 (5.24)	3.92 (5.48)	−2.28, 0.023
Physical Intimate Partner Violence
Male involvement index	7.10 (3.07)	7.39 (2.98)	6.20 (3.17)	−4.33,<0.001^a
Adherent to ARVs
No	224 (32.8%)	162 (31.3%)	62 (37.3%)
Yes	459 (67.2%)	355 (68.7%)	104 (62.7%)	2.06, 0.151

Note. ART = Antiretroviral Therapy. FET = Fisher’s Exact test.

^aMann Whitney U test was used to compare groups.

Table 2. Descriptive statistics of HV related stigma.

		Intervention		Control		P-value
Stigma dimension	Time	M	SD	M	SD
Personalised stigma	1	32.5	10.9	33.5	8.8	<0.001
	2	31.4	10.3	35.3	11.7
Disclosure concerns	1	19.2	3.9	20.6	4.1	<0.001
	2	18.3	4.4	20.5	4.6
Negative self-image	1	17.1	4.1	18.1	4.0	<0.001
	2	16.9	4.1	19.0	4.7
Concern with public attitudes	1	17.6	5.5	18.7	4.6	<0.001
	2	16.8	5.4	19.3	6.1
Overall	1	86.3	21.8	90.8	18.3	<0.001
	2	83.4	21.8	94.1	24.8

Table 3. Bivariate and multivariable multinomial logistic regressions with ‘Stable no Stigma’ (prenatal and 12 months postnatal) as reference group (n = 222).

	Stable Stigma (n = 57)		Change to Stigma (n = 63)		Change to No Stigma (n = 103)
	OR [95% CI]	AOR [95% CI]^a	OR [95% CI]	AOR [95% CI]^a	OR [95% CI]	AOR [95% CI]^a
Fixed Effects
Intervention	0.57 [0.33, 0.98]*	0.63 [0.35,1.05]	0.52 [0.34, 0.79]**	1.98 [0.99, 3.94]^	1.32 [0.87, 2.02]	0.50 [0.31, 0.79]**
Covariates (Baseline)
Age	1.08 [1.04, 1.13]***	1.06 [1.00,1.11]*	0.96 [0.92, 1.00]*	0.94 [0.89,0.99]*	0.99 [0.95, 1.03]	–
Educational Attainment (ref = up to 10 years)
10 to 11 years	1.29 [0.65, 2.57]	–	0.93 [0.55, 1.57]	–	0.66 [0.39, 1.09]	–
12 years or more	0.99 [0.46, 2.17]	–	0.88 [0.49, 1.59]	–	0.62 [0.35, 1.10]	–
Monthly Income	1.16 [0.69, 1.94]	–	0.95 [0.62, 1.43]	–	0.84 [0.55, 1.28]	–
Relationship Status (ref = unmarried living separate)
Unmarried, living together	0.87 [0.44, 1.72]	–	0.84 [0.50, 1.42]	–	0.88 [0.51,1.49]	–
Married	1.39 [0.73, 2.63]	–	0.74 [0.41, 1.32]	–	0.99 [0.56,1.72]
Pregnancy Unplanned	1.04 [0.62, 1.76]	–	1.34 [0.88, 2.04]	–	0.95 [0.62,1.45]	–
Diagnosed during this pregnancy	0.81 [0.48, 1.35]		1.60 [1.04, 2.46]*	1.57 [0.78, 3.15]	1.19 [0.78, 1.83]	–
Months Since ART Initiation	1.01 [1.01, 1.02]**	1.01 [0.99, 1.02]	1.00 [1.00, 1.01]	–	0.99 [0.98, 1.00]*	1.00 [0.99,1.01]
HIV Positive Children	3.02 [1.23, 7.43]*	2.11 [0.67,5.53]	1.14 [0.42, 3.08]	–	0.43 [0.10, 1.85]	–
HIV Positive Partner	0.93 [0.50, 1.70]	–	0.66, 0.39, 1.12]	–	0.79 [0.48, 1.32]	–
Alcohol Use	1.23 [0.60, 2.50]	–	0.63 [0.32, 1.26]	–	1.84 [1.07, 3.15]*	0.71 [0.32, 1.57]
Disclosure of HIV Status to Partner	0.65 [0.38, 1.09]^	0.65 [0.31,1.18]	0.66 [0.44, 1.01]^	1.18 [0.60, 2.31]	0.65 [0.43, 0.99]*	0.66 [0.38,1.19]
Male Involvement	0.88 [0.81, 0.95]**	0.88 [0.79, 0.96]*	0.97 [0.91, 1.04]	–	0.91 [0.86, 0.98]**	0.96 [0.88,1.05]
Psychological Intimate Partner Violence	1.01 [0.96, 1.05]	–	1.01 [0.97, 1.04]	1.03 [0.97, 1.09]	1.04 [1.00, 1.07]*	1.02 [0.95, 1.06]
Physical Intimate Partner Violence	0.99 [0.92, 1.07]	–	1.00 [0.94, 1.06]	–	1.09[1.04, 1.14]***	1.04 [0.95, 1.14]
Depression	1.02 [0.61, 1.71]		0.791 [0.52, 1.20]	–	2.27 [1.46,3.52]***	0.90 [0.57, 1.43]
Adherence	1.21 [1.00, 1.47]*	1.17 [0.95, 1.40]	1.03 [0.93,1.15]	–	0.88 [0.81, 0.96]**	1.03 [0.91, 1.16]
Model Fit
-2LL (Deviance)	−144.96		−102.83		−246.47
Number of Parameters	8		6		10
AIC/BIC	305.93/337.28		217.66/236.29		512.94/555.27

Note. AOR = Adjusted Odds Ratio.

^aThe odds ratio for each independent variable is adjusted by each of the other variables in the model.

***P < 0.001.

**P < 0.01.

*P < 0.05.

^P < 0.10.

Table 4. Predictors of HIV related stigma at baseline and 12-months postnatally.

Variable	Coefficients (95% CI)
Model 1: Baseline characteristics (time-invariant)
Age	0.020 [−0.079, 0.119]
Education
0-Grade 9	1 (Reference)
Grade 10–11	0.430 [−0.609, 1.469]
Grade 12 or more	−0.386 [−1.659, 0.886]
Employed
No	1 (Reference)
Yes	1.449 [0.333, 2.564]*
Income
600 or more	1 (Reference)
<600 Rand	−0.876 [−1.801, 0.050]
Relationship status
Unmarried, living separate	1 (Reference)
Unmarried, living together	−0.334 [−1.525, 0.857]
Married	0.841[−0.335, 2.016]
Pregnancy unplanned
No	1 (Reference)
Yes	0.213 [−0.666, 1.091]
Diagnosed during this pregnancy
No	1 (Reference)
Yes	1.190 [0.083, 2.296]*
Months since ART initiation	0.000 [−0.017, 0.017]
HIV positive children
No	1 (Reference)
Yes	0.064 [−1.546, 1.675]
HIV serostatus of spouse/partner
Negative/Do not know	1 (Reference)
Positive	−0.459 [−1.559, 0.641]
Alcohol (>2 drinks last month)
No	1 (Reference)
Yes	−1.185 [−2.343, −0.027]*
Random Effects^a
Intercept (baseline)	−0.069 [−2.264, 5.227]
Stigma	16.60 [−3.121, 2.984]
Model 2: Variables assessed at two assessments (time-varying)
Fixed Effects
Intervention
Standard of care	1 (Reference)
Enhanced intervention	−1.391 [−2.128, −0.653]***
Disclosure of HIV Status to Partner	0.839 [−2.312, 3.989]
Male Involvement	−1.289 [−1.853, −0.725]***
Psychological Intimate Partner Violence	0.492 [−1.195, 2.180]
Physical Intimate Partner Violence	2.175 [−0.153, 4.504]
Adherence to ARVs	2.485 [−3.293, 8.264]
Consistent condom use (past week)	−0.418 [−3.055, 2.219]*
Noncondom use at last sex	−3.798 [−6.697, −0.899]
HIV Knowledge	0.250 [−0.367, 0.867]
Depression	2.293 [−0.364, 4.949]
Random Effects^a
Intercept (baseline)	10.246 [8.154, 12.339]***
Stigma	12.764 [10.836, 14.693]***

CI = Confidence Interval.

^aRandom effects indicates the estimated variances from random effects logistic regression model.

***P < 0.001.

**P < 0.01.

*P < 0.05.