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Geographic distribution of HIV stigma among women of childbearing age in rural Kenya

Akullian, Adama; Kohler, Pamelab,c; Kinuthia, Johne; Laserson, Kaylah; Mills, Lisa A.f,g; Okanda, Johng; Olilo, Georgeg; Ombok, Mauriceg; Odhiambo, Frankg; Rao, Deepab; Wakefield, Jonathand; John-Stewart, Gracea,b

doi: 10.1097/QAD.0000000000000318
Epidemiology and Social

Objective(s): HIV stigma is considered to be a major driver of the HIV/AIDS pandemic, yet there is a limited understanding of its occurrence. We describe the geographic patterns of two forms of HIV stigma in a cross-sectional sample of women of childbearing age from western Kenya: internalized stigma (associated with shame) and externalized stigma (associated with blame).

Design: Geographic studies of HIV stigma provide a first step in generating hypotheses regarding potential community-level causes of stigma and may lead to more effective community-level interventions.

Methods: Spatial regression using generalized additive models and point pattern analyses using K-functions were used to assess the spatial scale(s) at which each form of HIV stigma clusters, and to assess whether the spatial clustering of each stigma indicator was present after adjustment for individual-level characteristics.

Results: There was evidence that externalized stigma (blame) was geographically heterogeneous across the study area, even after controlling for individual-level factors (P = 0.01). In contrast, there was less evidence (P = 0.70) of spatial trend or clustering of internalized stigma (shame).

Conclusion: Our results may point to differences in the underlying social processes motivating each form of HIV stigma. Externalized stigma may be driven more by cultural beliefs disseminated within communities, whereas internalized stigma may be the result of individual-level characteristics outside the domain of community influence. These data may inform community-level interventions to decrease HIV-related stigma, and thus impact the HIV epidemic.

aUniversity of Washington, School of Public Health and Community Medicine, Department of Epidemiology

bUniversity of Washington Schools of Public Health and Medicine, Department of Global Health

cUniversity of Washington School of Nursing

dUniversity of Washington, Department of Statistics, Seattle, Washington, USA

eUniversity of Nairobi, Nairobi, Kenya

fDivision of HIV/AIDS Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA

gKenya Medical Research Institute/CDC Research and Public Health Collaboration, Kisumu, Kenya

hCenter for Global Health, CDC, Atlanta, Georgia, USA.

Correspondence to Adam Akullian, MS, University of Washington, School of Public Health and Community Medicine, Department of Epidemiology, Box 357236, Seattle, WA 98195, USA. Tel: +1 206 543 1065; fax: +1 206 543 8525; e-mail:

Received 2 December, 2013

Revised 23 April, 2014

Accepted 24 April, 2014

© 2014 Lippincott Williams & Wilkins, Inc.