HIV Stigma Among Men in Tanzania: A Mixed-method Study

Background: HIV-related stigma is a barrier to the success of programs targeting the prevention and treatment of HIV. In Sub Saharan Africa, where the HIV epidemic is concentrated, men play a critical role in defining and shaping social constructs, including HIV stigma. This study aimed to describe HIV stigmatizing attitudes, to identify factors associated with stigmatizing attitudes, and to explore the broader context of HIV stigmatizing attitudes among men in Tanzania. Methods: This mixed-method study recruited 489 men from antenatal clinics of two public primary health care facilities in Moshi municipality, Tanzania. Participants completed a structured survey using audio computer assisted self-interviewing technology; a subset of 16 men completed in-depth interviews. HIV stigmatizing attitudes were examined using a modified version of the Personal Stigma Scale, and logistic regression models identified associating factors. Qualitative data were analyzed using applied thematic analysis. Results: The majority (72%, n=356) of participants endorsed at least one of the stigmatizing attitudes; the most common attitude endorsed was a perception of HIV is a punishment for bad behavior (37%, n=180). In a multivariable logistic analysis, men with only primary education were twice as likely as those with secondary or high to hold high stigmatizing attitudes (OR=2.05, 95% CI 1.39, 3.04). Qualitative analysis revealed that masculine identity intensified the vulnerability of men towards HIV stigma, while HIV testing experience spurred behavior change to reduce HIV risk behavior. Conclusions: HIV stigmatizing attitudes are prevalent among men. Comprehensive community-based stigma reduction programs to provide a supportive environment for men are crucial to increase uptake of HIV testing and treatment services.