Determinants of shame in the stigmatization of self-reported women with human immunodeficiency virus in Kenya; A secondary analysis of 2022 Kenya demographic and health survey data

Determinants of shame in the stigmatization of self-reported women with human immunodeficiency virus in Kenya; A secondary analysis of 2022 Kenya demographic and health survey data | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinants of shame in the stigmatization of self-reported women with human immunodeficiency virus in Kenya; A secondary analysis of 2022 Kenya demographic and health survey data Isaac Isiko, Simon Nyegenye, Lenz Nwachinemere Okoro, Aaron Mwesigwa, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4660307/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose: HIV/AIDS is a highly prevalent infectious diseasemostly in sub-Saharan Africa,and several strategies have been put in place to reduce its spread. This study aimed to assess the determinants of shame in the stigmatization of self-reported women with HIV in Kenya. Methods: The data used in this study were obtained from the 2022 KDHS. The statistical analysis included 332 women aged 15-49 years who reported that their test results indicated that they were HIV positive, and the analysis considered the complex survey design; hence, weights were applied. All the statistical analyses were conducted using STATA 17. Results: Women whose HIV status was disclosed by someone else (AOR=1.98, 95% CI: 1.08-3.65, P=0.028) had significantly greater odds of feeling ashamed than did their counterparts whose status was not disclosed. Although not statistically significant, beingaged 20-24 years (AOR=3.65, 95% CI: 0.66-20.14, P=0.24) and experiencingverbal abuse from healthcare workers (AOR=3.73, 95% CI: 0.84-16.56, P=0.08) werealso factors associated withincreased odds of experiencingshame. Conclusion: Factors contributing to shame among HIV-positive women include community gossip, unauthorized disclosure of status, verbal harassment, and negative treatment by health workers; addressing these problems is very important for addressing HIV-related stigma, improving HIV testing rates, and ensuring better access to treatment, especially among women living in rural areas. HIV stigma Human immunodeficiency virus HIV among women Shame Kenya Introduction Millions of people worldwide continue to be afflicted by HIV/AIDS, which continues to be one of the greatest global health issues. Several worldwide mitigation strategies have been developed and put into action since the disease's emergence to lessen its effects and eventually eliminate it.[ 1 ] However, the HIV epidemic continues to disproportionately affect certain regions and populations [ 2 ], with sub-Saharan Africa (SSA) carrying the highest burden of the epidemic, accounting for roughly two-thirds of all new HIV infections globally.[ 3 ] In Kenya, 1.7 million new cases were recorded in 2019, with one in four new infections being obtained from young women and adolescent girls.[ 4 ] A study performed in 28 sub-Saharan countries reported a combined HIV prevalence of 56.1% among people living with HIV for women of reproductive age.[ 5 ] In Kenya, the HIV prevalence rate among adults aged 15–64 years was estimated to be in 2014, with women bearing a higher burden of 6.9% compared to 4.4% for men. [ 6 ] The unequal impact of the HIV epidemic on women can be attributed to a variety of factors, ranging from biological, social, behavioural, cultural, economic, and structural factors. In SSA, a combination of these variables has resulted in an imbalance in the rates of HIV infection among women compared to their male peers. [ 7 ] Despite substantial success in improving access to antiretroviral medication (ART) and lowering AIDS-related fatalities, HIV-related stigma and discrimination continue to be pertinent hurdles to HIV prevention, testing, and treatment adherence.[ 8 ] One of the most significant challenges faced by women living with HIV (WLHIV) in Kenya is the pervasive stigma and discrimination associated with the condition. HIV-related stigma manifests in various forms, including social rejection, discrimination in healthcare and employment settings, and psychological distress due to internalized stigma.[9 10] A particularly pernicious aspect of HIV-related stigma is shame, which can have profound psychological and social consequences, especially for WLHIV.[ 11 ] Shame is considered a negative emotion that develops when someone perceives themselves or some aspect of themselves as inadequate, improper, or immoral or when they believe they are being assessed by others real, imagined, or perceived—to be faulty in some significant way. Because the object of shame is oneself and because it also entails awareness of how others perceive oneself, it is referred to as a self-conscious emotion.[ 12 ] It is a powerful force that can increase the detrimental impact of HIV stigma, leading to social disengagement, poor self-care, and decreased adherence to therapy.[ 13 ] It is one of the most severe and debilitating types of stigma experienced by people living with HIV (PLHIV) and is a self-conscious emotion marked by feelings of inadequacy, inferiority, and a desire to hide or conceal one's disease.[ 14 ] The experience of shame among PLHIV is not uniform. It has been associated with several factors, such as sociodemographic characteristics, cultural norms, and the particular environment in which people reside. [ 15 ] In many sub-Saharan African countries, including Kenya, traditional gender norms and power dynamics may heighten the shame experienced by women living with HIV. [ 7 ] Women in these contexts frequently suffer heightened stigma and prejudice due to their perceived violation of cultural standards concerning sexual behaviour and parenthood. [ 16 ] The social and cultural conventions in Kenya regarding gender, sexual orientation, and HIV exacerbate the shame that the WLHIV faces. The idea that HIV is a result of promiscuity or moral flaws is perpetuated by patriarchal systems and traditional gender roles, which frequently stigmatize and blame women for contracting the disease. [ 17 ] Shame can also result from the stigmatization of HIV/AIDS, which is frequently perceived as the result of socially unacceptable actions, including drug use or promiscuity. [ 18 ] WLHIVs may experience feelings of self-loathing and devaluation as a result of this perception in addition to the clinical symptoms of HIV and related illnesses. [ 19 ] Furthermore, shame may hinder WLHIVs from obtaining appropriate medical care or adhering to treatment regimens, as it fosters a desire to conceal one's HIV status and avoid circumstances that may lead to further stigmatization. [ 13 ] The self-reported behaviour of women with HIV in Kenya is a crucial aspect of understanding and addressing the HIV/AIDS epidemic in the country. There are significant challenges associated with self-reported HIV status among women in Kenya. A study by Wanjala and colleagues reported psychological issues such as despair, anxiety, mood swings, low self-esteem, and melancholy. Their inability to accept their HIV diagnosis made it difficult for them to tell people about it, take their antiretrovirals as prescribed, and interact with the community.[ 9 ] In another study, women with less education, who resided in rural areas, and who had limited access to healthcare facilities were less likely to report their HIV status.[ 20 ] Gender inequality and power imbalances in relationships can also impede women's self-informing behaviour in Kenya.[ 4 ] Several studies have explored the factors associated with HIV-related shame and stigma in Kenya, but few have specifically examined the determinants of shame in stigmatization among WLHIVs. By examining the determinants of shame within the context of the HIV Stigma Framework, this study aims to provide insights into the complex interplay between individual, interpersonal, and structural factors that contribute to the stigmatization and shame experienced by self-reported women living with HIV in Kenya. These findings can inform the development of multilevel interventions that address both the individual and societal drivers of shame, promoting greater resilience, self-acceptance, and overall well-being among this vulnerable population. Methods Study Area Kenya is located in the East African region. The country is organized into 8 regions, including the western region, which is under study. There are also 47 counties in the 8 regions. The Kenyan western region is located in the southwestern corner of the country, sharing borders with Lake Victoria to the south, where the Rift Valley region is located to the east and Uganda to the west. It forms an interlocking circle and is composed of many counties, including Kakamega, Bungoma, Busia, Vihiga and parts of Trans Nzoia and Siaya. The picture is beautiful - green scenery, little hills and plains that are cultivated to grow the main crops. In addition, it is famous because of its multifaceted cultural variation, sophisticated markets and flourishing towns. The scopes of importance to this region are the quiescent anchorage of Kisumu, Kakamega, and Eldoret. Sample Design and Study Population KDHS 2022 was drawn from the Kenya Household Master Sample Frame (K-HMSF), which was obtained from the 2019 Kenya Population and Housing Census[ 26 ]. The frame included 10,000 last places (LPEAs) selected with a systematic probability proportional to size. Using either the K-Means method or its variation K-Hierarchical method, the maximum number of clusters in rural and urban parts of the area was 1692 subclusters. The Epsom method of cluster selection, with a two-stage stratified sample design, was used. Household sampling was conducted in all selected clusters, with the principle of cluster division being 25 households from each cluster, resulting in data for 42,022 households. K-HMSFs were sampled from the 2019 Kenya Population and Housing Census. From this 10EA, which was randomly taken from different locations, the K-HMSFs were developed using subsample data. The residents of the 47 counties were divided into two parts, rural and urban gates, which ultimately had a total of 92 places according to the uniting factor[ 26 ]. The survey questions involved Mombasa County and Nairobi city, which are considered to be entirely urban regions. For a sample size of 42,300 households, a total of 1,692 clusters were established, 1,026 of which were rural and 666 of which were urban[ 26 ]. Two two-stage stratified sample designs based on cluster random selection of 1692 clusters were adopted. Regarding the sampling technique utilized, the sample clusters were randomly generated using an Epsom (equal probability sampling), K-HMSF. The door-to-door listing will be initiated in all the clusters, and 25 households will constitute a cluster. Subsidies were provided, and clusters with fewer than 25 members were customized for those neighborhoods. CAPI was the main tool within IPA (Interviewer's Assistance), which was utilized to establish clusters of 100 households in each required planning. The principle of not duplication was upheld by creating one enumeration district that was used for several enumeration segments. Data collection Four questionnaires were used in KDHS 2022: Household, Man’s, Woman’s, and Biomarker. The survey questionnaires gathered rich information on household attributes, demographic issues, indicators of health, and anthropometry measurements [ 26 ]. In parallel, a Fieldworker Questionnaire was employed to provide an official portrait of the survey team. The questionnaires were translated into the national language 'Kiswahili' and were administered via a computer-assisted personal interview approach for more efficient data collection. Variable definitions. In this study, two types of variables were included: the outcome variable and the predictor/exposure variables. The outcome variable of interest was feeling ashamed of HIV-positive status disclosure, which is binary (agreed to shame or disagreed to shame). The exposure variables in the study included whether the respondent was stigmatized, which was measured by 5 variables that were binary in nature (yes or no); people felt stigmatized because people talked badly; someone else disclosed their HIV status; they were verbally insulted, harassed or threatened; health care workers talked badly; and health care workers verbally abused the patients. Age category in 5-year groups (15–19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49), residence type (rural or urban), and self-reported health status (very good, good, moderate or bad) Data analysis The statistical analysis included 332 women aged 15–49 years whose test results indicated that they were HIV positive. The analysis considered the complex survey design, and weights were applied to ensure representativeness and to correct for nonresponse. A descriptive analysis of the outcome of the study with the predictor variables was carried out to generate the weighted frequencies and percentages. Binary logistic regression and multivariate logistic regression were performed, and the corresponding unadjusted odds ratios and adjusted odds ratios, respectively, were recorded. All the statistical analyses were conducted using STATA 17. Results Table 1 shows the association between the percentage of HIV-positive patients who felt ashamed or not ashamed because of their HIV status by selected background characteristics. Feeling ashamed among HIV-positive patients varied based on age, place of residence, health status, and negative social interactions. Younger HIV patients aged 15-19 years were less likely to feel ashamed (21%), with 78.7% disagreeing with feeling ashamed, whereas those in the 45-49 years age group showed higher levels of shame, with only 53.8% disagreeing. Compared with urban residents, rural residents were more likely to feel ashamed, with 38.6% in rural areas agreeing with feeling ashamed versus 36% in urban areas. Patients reporting excellent health were more likely to feel ashamed (47.2% agree) than those reporting moderate health (29.7% agree). A total of 52.3% of the patients with poor health status agreed that they felt ashamed. Experiences related to HIV status also played a significant role: patients who did not face negative talk from others showed greater disagreement with feeling ashamed (69.5%), while those who faced negative talk had greater agreement (52%). Similarly, patients who did not experience verbal insults or harassment disagreed more with feeling ashamed (66.7%) than did those who did (46.6%). Table 1: Descriptive results of HIV+ women who felt ashamed and not ashamed because of their HIV status according to selected background characteristics Variables disagree agree N =332 % n % n age in 5 year groups 15-19 78.7 7 21.3 2 9 20-24 50.8 10 49.2 9 19 25-29 60.9 15 39.1 9 24 30-34 65.2 32 34.8 17 48 35-39 66.9 55 33.1 27 82 40-44 64.5 51 35.5 28 78 45-49 53.8 38 46.2 33 71 type of place of residence urban 64 69 36 39 108 rural 61.4 137 38.6 86 224 self-reported health status very good 52.8 17 47.2 15 32 good 62.2 82 37.8 50 132 moderate 70.3 85 29.7 36 122 bad 47.7 22 52.3 24 46 things happened because HIV positive status: people talk badly no 69.5 153 30.5 67 220 yes 48 54 52 58 112 things happened because HIV positive status: someone else disclosed the status no 68.5 161 31.5 74 235 yes 47.2 46 52.8 51 97 things happened because HIV positive status: verbally insulted/harassed/threaten no 66.7 172 33.3 86 258 yes 46.6 34 53.4 39 74 things happened because HIV positive status: healthcare workers talked badly no 62.7 187 37.3 111 298 yes 58.6 20 41.4 14 34 things happened because HIV positive status: healthcare workers verbally abused no 63.2 200 36.8 117 317 yes 43.6 7 56.4 9 15 Table 2 shows the odds ratios and P values from the bivariate analysis, with factors individually associated with shame highlighted. Significant factors associated with shame included negative social interactions, such as people talking badly due to HIV status, disclosure of HIV status by others, and verbal harassment or abuse. Patients who experienced negative talk due to their HIV status had significantly greater odds of feeling ashamed (OR=2.29, 95% CI: 1.43-3.66, P=0.00). Similarly, those whose HIV status was disclosed by someone else were significantly more likely to feel ashamed (OR=2.52, 95% CI: 1.54-4.12; P=0.00). Verbal insults or harassment were also significantly associated with increased odds of feeling ashamed (OR=2.20, 95% CI: 1.29-3.77; P=0.004). Additionally, negative behaviour by healthcare workers was a strong factor, with patients experiencing negative talk from healthcare workers showing significantly greater odds of shame (OR=2.81, 95% CI: 1.24-6.34, P=0.013) and those verbally abused by healthcare workers having even greater odds of feeling ashamed (OR=6.57, 95% CI: 1.82-23.74, P=0.004). Table 2: Bivariate association of shame among HIV+ patients by selected background characteristics Variables UOR (95% CI) P value age in 5 year groups 15-19 1.00 (1.00, 1.00) 20-24 3.37 (0.68, 17.00) 0.14 25-29 2.49 (0.53, 11.81) 0.25 30-34 1.58 (0.38, 6.61) 0.53 35-39 1.67 (0.42, 6.63) 0.47 40-44 2.16 (0.54, 8.65) 0.28 45-49 2.32 (0.58, 9.31) 0.23 type of place of residence urban 1.00 (1.00, 1.00) rural 0.95 (0.62, 1.56) 0.95 self reported health status very good 1.00 (1.00, 1.00) good 0.82 (0.38, 1.75) 0.61 moderate 0.60 (0.27, 1.31) 0.20 bad 1.98 (0.79, 4.98) 0.15 very bad 1 things happened because hiv positive status: people talk badly no 1.00 (1.00,1.00) yes 2.29 (1.43, 3.66) 0.00 *** things happened because HIV positive status: someone else disclosed the status no 1.00 (1.00, 1.00) yes 2.52 (1.54, 4.12) 0.00 *** things happened because HIV positive status: verbally insulted/harassed/threaten no 1.00 (1.00, 1.00) yes 2.20 (1.29, 3.77) 0.004 *** things happened because HIV positive status: healthcare workers talked badly no 1.00 (1.00, 1.00) yes 2.81 (1.24, 6.34) 0.013** things happened because HIV positive status: healthcare workers verbally abused no 1.00 (1.00, 1.00) yes 6.57 (1.82, 23.74) 0.004 *** Note: ***p < 0.01, ** p < 0.05, UOR: Unadjusted odds ratio Table 3 presents the results from a multiple logistic regression model to establish factors associated with shame among HIV-positive women. The only factor found to be significantly related to feelings of shame was the disclosure of HIV status by someone else. Women whose HIV status was disclosed by someone else had significantly greater odds of feeling ashamed than did their counterparts whose status was not disclosed by others. (AOR=1.98, 95% CI: 1.08-3.65, P=0.028). Although not statistically significant, other factors were associated with increased odds of experiencing shame. For example, women aged 20-24 years had greater odds (AOR=3.65, 95% CI: 0.66-20.14, P=0.24), and those who experienced verbal abuse from healthcare workers also had greater odds (AOR=3.73, 95% CI: 0.84-16.56, P=0.08). Table 3: Logistic Regression Analysis of Factors Associated with Agreement to Shame among Self-Reported HIV-Diagnosed Patients in Kenya Characteristics AOR (95% CI) P- Value Age in 5-year groups 15-19 1 20-24 3.65 (0.66,20.32) 0.14 25-29 2.79 (0.54, 14.51) 0.22 30-34 1.75 (0.39, 7.95) 0.47 35-39 1.89 (0.44, 8.10) 0.39 40-44 2.23 (0.52, 9.48) 0.28 45-49 2.41 (0.56, 10.33) 0.24 type of place of residence urban 1 rural 0.99 (0.60, 1.63) 0.96 self-reported health status very good 1 good 0.84 (0.38, 1.87) 0.68 moderate 0.56 (0.24, 1.27) 0.16 bad 1.73 (0.67, 4.48) 0.26 things happened because HIV positive status: someone else disclosed the status no 1 yes 1.98 (1.08, 3.65) 0.028 ** things happened because HIV positive status: verbally insulted/harassed/threaten no 1 yes 1.30 (0.65, 2.62) 0.46 things happened because HIV positive status: healthcare workers talked badly no 1 yes 1.09 (0.39, 3.05) 0.87 things happened because HIV positive status: healthcare workers verbally abused no 1 yes 3.73 (0.84, 16.56) 0.08 Note: ***p < 0.01, ** p < 0.05, AOR: adjusted odds ratio Discussion The findings of this study revealed that more than one-third of the respondents agreed to have experienced shame because of their HIV-positive status. A slightly greater proportion of rural dwellers reported shame than did their urban counterparts. This proportion is higher than what was reported from a previous study in Nigeria, where 29% of respondents reported being ashamed because of their positive HIV status. This study, like the current study, also showed that more rural than urban dwellers reported shame about their HIV-positive status [ 21 ], most likely because discriminatory attitudes towards HIV are more prevalent in rural areas, as reported in other studies [ 22 , 23 ]. These studies stated that urban dwellers are more exposed to education about HIV through mass media and interaction with health personnel, thereby making them less discriminatory than their rural counterparts [ 22 ]. The high proportion of HIV-positive patients who reported shame, probably because of prevalent discriminatory attitudes, has serious implications for every level of control of the disease [ 24 ]. In this study, “people talking badly about the respondent’s HIV status”, “someone else disclosing status”, “verbal insults or harassment by members of their community” and “health workers talking badly or harassing the respondents” were all significantly associated with reporting shame. Women who were verbally insulted, harassed, or threatened because of their HIV-positive status were more likely to report shame than those who were not. This stigma and discrimination provide needless barriers across HIV prevention, testing, and treatment cascades. This is consistent with findings from previous studies where similar factors were associated with stigma and shame [ 21 , 25 ]. This study suggests a need for targeted interventions aimed at improving awareness and education about HIV, especially in rural communities of Kenya. This will result in reduced discriminatory attitudes towards the disease, thereby resulting in reduced shame and increased willingness to test for HIV and, in turn, access antiretroviral therapy without fear of experiencing shame. There will also be a need for training and retraining health workers in the areas of patient rights, dignity, and confidentiality. The management of health institutions and the National Medical Council should establish and implement disciplinary measures for health workers who verbally abuse or stigmatize HIV patients. Conclusion The findings of this study highlight the burden and determinants of shame among women living with HIV in Kenya, particularly among rural dwellers who experience higher levels of stigma than their urban counterparts. Key factors contributing to this shame include community gossip, unauthorized disclosure of status, verbal harassment, and negative treatment by health workers. Addressing these issues is crucial for mitigating stigma, improving HIV testing rates, and ensuring better access to treatment. Abbreviations AIDS Acquired immune deficiency syndrome HIV Human Immune Virus ART Antiretroviral therapy PLWHA People living with HIV/AIDS 2022 KDHS Kenya Demographic and Health Survey data 2022 KNBS Kenya National Bureau of Statistics MoH Ministry of Health DHS Demographic and Health Survey K-HMSF Kenya Household Master Sample Framework USAID United States Agency for International Development KPHC Kenya Population and Housing Census PMTCT Prevention of Mother-to-Child Transmission UOR Unadjusted odds ratio AOR Adjusted Odds Ratios Declarations Ethical approval and considerations Ethical approval was required for this study because it utilized secondary data. The authors obtained permission to use the secondary data from the DHS Program websitehttps://www.dhsprogram.com/data/available-datasets.cfm. The Demographic and Health Survey also ensured that all participants provided informed verbal consent to participate in the study, and for minors, their parents or guardians consented on their behalf. Consent for publication Not applicable Availability of data and materials The data used in this study can be accessed online through the DHS website upon request (https://dhsprogram.com/). Competing interest The authors declare no competing interests. Funding There was no funding for this study. Author contributions II conceptualized and drafted the manuscript. SN, LNO, and II performed the analyses and interpreted the results. AM, LNO, JMA, HO and II wrote the Introduction and Methodology sections. GNB wrote the discussion section and conclusion of the manuscript. BWS reviewed the first draft of the manuscript All authors reviewed and approved the final draft of the manuscript. Acknowledgement The authors acknowledge t he Kenya National Bureau of Statistics (KNBS) and the Ministry of Health (MoH) of Kenya for conducting the 2022 KDHS and disseminating the results and data online for accessibility and reuse. This was supported by funding provided by the United States Agency for International Development (USAID) and the Global Fund. The ICF also provided technical assistance through the DHS Program. References Kumah E, Boakye DS, Boateng R, Agyei E. Advancing the Global Fight Against HIV/Aids: Strategies, Barriers, and the Road to Eradication. Ann Glob Health. 2023;89(1). Global Health Policy. KFF. 2023 [cited 2024 May 7]. The Global HIV/AIDS Epidemic. Available from: https://www.kff.org/global-health-policy/fact-sheet/the-global-hiv-aids-epidemic/#endnote_link_594185-40 Moyo E, Moyo P, Murewanhema G, Mhango M, Chitungo I, Dzinamarira T. Key populations and Sub-Saharan Africa’s HIV response. Vol. 11, Frontiers in Public Health. 2023. Andrews C, Reuter TK, Marsh L, Velazquez JM, Jaoko W, Jolly P. Intimate partner violence, human rights violations, hhr_final_logo_alone.Indd 1 and hiv among women in Nairobi, Kenya. Health Hum Rights. 2020;22(2). Zegeye B, Adjei NK, Ahinkorah BO, Tesema GA, Ameyaw EK, Budu E, et al. HIV testing among women of reproductive age in 28 sub-Saharan African countries: a multilevel modelling. Int Health. 2023;15(5). Kimanga DO, Ogola S, Umuro M, Ng’ang’a A, Kimondo L, Murithi P, et al. Prevalence and incidence of HIV infection, trends, and risk factors among persons aged 15-64 years in Kenya: Results from a nationally representative study. J Acquir Immune Defic Syndr (1988). 2014;66(SUPPL. 1). Ramjee G, Daniels B. Women and HIV in Sub-Saharan Africa. Vol. 10, AIDS Research and Therapy. 2013. Stangl AL, Earnshaw VA, Logie CH, Van Brakel W, Simbayi LC, Barré I, et al. The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17(1). Wanjala SW, Nyongesa MK, Mapenzi R, Luchters S, Abubakar A. A qualitative inquiry of experiences of HIV-related stigma and its effects among people living with HIV on treatment in rural Kilifi, Kenya. Front Public Health. 2023;11. Stangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? Vol. 16, Journal of the International AIDS Society. 2013. Nabunya P, Namuwonge F. HIV-Related Shame, Stigma and the Mental Health Functioning of Adolescents Living with HIV: Findings from a Pilot Study in Uganda. Child Psychiatry Hum Dev. 2023;54(6). Dolezal L, Lyons B. Health-related shame: An affective determinant of health? Med Humanit. 2017;43(4). Hutchinson P, Dhairyawan R. Shame and HIV: Strategies for addressing the negative impact shame has on public health and diagnosis and treatment of HIV. Bioethics. 2018;32(1). Bennett DS, Traub K, Mace L, Juarascio A, O’Hayer CV. Shame among people living with HIV: A literature review. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV. 2016;28(1). Li Z, Morano JP, Khoshnood K, Hsieh E, Sheng Y. HIV-related stigma among people living with HIV/AIDS in rural Central China. BMC Health Serv Res. 2018;18(1). Hussein J, Ferguson L. Eliminating stigma and discrimination in sexual and reproductive health care: a public health imperative. Vol. 27, Sexual and Reproductive Health Matters. 2019. Akatukwasai C, Getahun M, Ayadi AME, Namanya J, Maeri I, Itiakorit H, et al. Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV “test and treat” trial. PLoS One. 2021;16(5 May 2021). Chan KY, Stoové MA, Reidpath DD. Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: A study of Thai nurses’ attitudes. Harm Reduct J. 2008;5. Chambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, et al. Stigma, HIV and health: A qualitative synthesis. Vol. 15, BMC Public Health. 2015. H G, PE J, T J, R G, W J, LA P. Characteristics Associated with Disclosure Status to Sexual Partners among Kenyan Women. J HIV AIDS. 2019;5(2). Adekoya P, Lannap FD, Ajonye FA, Amadiegwu S, Okereke I, Elochukwu C, et al. Experiences of stigmatization and discrimination in accessing healthcare services among people living with HIV (PLHIV) in Akwa Ibom State, Nigeria. HIVAIDS Auckl NZ. 2024 Feb 19;16:45–58. Diress GA, Ahmed M, Linger M. Factors associated with discriminatory attitudes towards people living with HIV among adult population in Ethiopia: analysis on Ethiopian demographic and health survey. SAHARA J J Soc Asp HIVAIDS Res Alliance. 2020 Dec;17(1):38–44. Egbe TO, Nge CA, Ngouekam H, Asonganyi E, Nsagha DS. Stigmatization among People Living with HIV/AIDS at the Kumba Health District, Cameroon. J Int Assoc Provid AIDS Care. 2020;19:2325958219899305. Hutchinson P, Dhairyawan R. Shame and HIV: Strategies for addressing the negative impact shame has on public health and diagnosis and treatment of HIV. J Bioeth. 2017 Aug 23;32. Valencia-Garcia D, Rao D, Strick L, Simoni JM. Women’s experiences with HIV-related stigma from health care providers in Lima, Peru: “I would rather die than go back for care.” Health Care Women Int. 2017 Feb;38(2):144–58. KNBS and ICF. 2023. Kenya Demographic and Health Survey 2022: Volume 1. Nairobi, Kenya, and Rockville, Maryland, USA: KNBS and ICF. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4660307","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":324687595,"identity":"52e50735-1119-4e7e-80a7-6efc36582403","order_by":0,"name":"Isaac Isiko","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA70lEQVRIiWNgGAWjYBACNjBpwMAjwcDY+OADSISdeC3MzYYzQCLMxFonwcDeJs0DYhHSwsd/+OGHHwV1MpLtjQ3SNr+2yfMxMzB++JiDx2ESacaSPQaHeaR5DjYY5/bdNmxjZmCWnLkNnxYGA2kGgwM8chKJDcm5PbcZgVrYmHnxaeE//vk3g0EdWMthy57b9oS1MOSYAW1h5pGWSGxsZvhxO5GwFomcMkuQXyR7DjYz9jbcTm5jZmzG6xf5/uObb/z4U2cvcbz9+Y8ff27bzm9vPvjhIx4tqICxDUw2EKseBP6QongUjIJRMApGCgAAnbJJOO7foVUAAAAASUVORK5CYII=","orcid":"","institution":"Makerere University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"","lastName":"Isiko","suffix":""},{"id":324687597,"identity":"0e608e68-640d-4b9b-a88e-d6a9128ef921","order_by":1,"name":"Simon Nyegenye","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Simon","middleName":"","lastName":"Nyegenye","suffix":""},{"id":324687599,"identity":"0c6a25c5-aac3-4b9e-a5a5-6719b63633ce","order_by":2,"name":"Lenz Nwachinemere Okoro","email":"","orcid":"","institution":"David Umahi Federal University Teaching Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lenz","middleName":"Nwachinemere","lastName":"Okoro","suffix":""},{"id":324687600,"identity":"5124321a-6a5e-4910-8590-2a1a4961fbc2","order_by":3,"name":"Aaron Mwesigwa","email":"","orcid":"","institution":"Marwadi University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Aaron","middleName":"","lastName":"Mwesigwa","suffix":""},{"id":324687603,"identity":"35e927e2-b4ea-4a08-be1f-4335b2f3779a","order_by":4,"name":"Gadzama Naya Bulus","email":"","orcid":"","institution":"Abubakar Tafawa Balewa University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Gadzama","middleName":"Naya","lastName":"Bulus","suffix":""},{"id":324687604,"identity":"07d7b53c-be14-41f0-bdb6-9d77d8f500ec","order_by":5,"name":"Jackson Micheal Asingwire","email":"","orcid":"","institution":"Marwadi University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jackson","middleName":"Micheal","lastName":"Asingwire","suffix":""},{"id":324687605,"identity":"47cd7205-a59f-4454-ae53-c43ae371ec8f","order_by":6,"name":"Haron Olot","email":"","orcid":"","institution":"Kampala International University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Haron","middleName":"","lastName":"Olot","suffix":""},{"id":324687608,"identity":"999f0d55-7269-4567-833e-ac410d57434a","order_by":7,"name":"Benjamin Wafula Simiyu","email":"","orcid":"","institution":"Uzima University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Benjamin","middleName":"Wafula","lastName":"Simiyu","suffix":""}],"badges":[],"createdAt":"2024-06-29 17:54:31","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4660307/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4660307/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":99313566,"identity":"a3702203-a82d-49cb-b795-f89c5a5e2c9e","added_by":"auto","created_at":"2025-12-31 16:20:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1515622,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4660307/v1/ff5eaeb8-942f-4235-ad33-beaf6138d721.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Determinants of shame in the stigmatization of self-reported women with human immunodeficiency virus in Kenya; A secondary analysis of 2022 Kenya demographic and health survey data","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMillions of people worldwide continue to be afflicted by HIV/AIDS, which continues to be one of the greatest global health issues. Several worldwide mitigation strategies have been developed and put into action since the disease's emergence to lessen its effects and eventually eliminate it.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] However, the HIV epidemic continues to disproportionately affect certain regions and populations [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e], with sub-Saharan Africa (SSA) carrying the highest burden of the epidemic, accounting for roughly two-thirds of all new HIV infections globally.[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] In Kenya, 1.7\u0026nbsp;million new cases were recorded in 2019, with one in four new infections being obtained from young women and adolescent girls.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] A study performed in 28 sub-Saharan countries reported a combined HIV prevalence of 56.1% among people living with HIV for women of reproductive age.[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] In Kenya, the HIV prevalence rate among adults aged 15\u0026ndash;64 years was estimated to be in 2014, with women bearing a higher burden of 6.9% compared to 4.4% for men. [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] The unequal impact of the HIV epidemic on women can be attributed to a variety of factors, ranging from biological, social, behavioural, cultural, economic, and structural factors. In SSA, a combination of these variables has resulted in an imbalance in the rates of HIV infection among women compared to their male peers. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eDespite substantial success in improving access to antiretroviral medication (ART) and lowering AIDS-related fatalities, HIV-related stigma and discrimination continue to be pertinent hurdles to HIV prevention, testing, and treatment adherence.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] One of the most significant challenges faced by women living with HIV (WLHIV) in Kenya is the pervasive stigma and discrimination associated with the condition. HIV-related stigma manifests in various forms, including social rejection, discrimination in healthcare and employment settings, and psychological distress due to internalized stigma.[9 10] A particularly pernicious aspect of HIV-related stigma is shame, which can have profound psychological and social consequences, especially for WLHIV.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] Shame is considered a negative emotion that develops when someone perceives themselves or some aspect of themselves as inadequate, improper, or immoral or when they believe they are being assessed by others real, imagined, or perceived\u0026mdash;to be faulty in some significant way. Because the object of shame is oneself and because it also entails awareness of how others perceive oneself, it is referred to as a self-conscious emotion.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] It is a powerful force that can increase the detrimental impact of HIV stigma, leading to social disengagement, poor self-care, and decreased adherence to therapy.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] It is one of the most severe and debilitating types of stigma experienced by people living with HIV (PLHIV) and is a self-conscious emotion marked by feelings of inadequacy, inferiority, and a desire to hide or conceal one's disease.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe experience of shame among PLHIV is not uniform. It has been associated with several factors, such as sociodemographic characteristics, cultural norms, and the particular environment in which people reside. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] In many sub-Saharan African countries, including Kenya, traditional gender norms and power dynamics may heighten the shame experienced by women living with HIV. [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] Women in these contexts frequently suffer heightened stigma and prejudice due to their perceived violation of cultural standards concerning sexual behaviour and parenthood. [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] The social and cultural conventions in Kenya regarding gender, sexual orientation, and HIV exacerbate the shame that the WLHIV faces. The idea that HIV is a result of promiscuity or moral flaws is perpetuated by patriarchal systems and traditional gender roles, which frequently stigmatize and blame women for contracting the disease. [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] Shame can also result from the stigmatization of HIV/AIDS, which is frequently perceived as the result of socially unacceptable actions, including drug use or promiscuity. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] WLHIVs may experience feelings of self-loathing and devaluation as a result of this perception in addition to the clinical symptoms of HIV and related illnesses. [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] Furthermore, shame may hinder WLHIVs from obtaining appropriate medical care or adhering to treatment regimens, as it fosters a desire to conceal one's HIV status and avoid circumstances that may lead to further stigmatization. [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe self-reported behaviour of women with HIV in Kenya is a crucial aspect of understanding and addressing the HIV/AIDS epidemic in the country. There are significant challenges associated with self-reported HIV status among women in Kenya. A study by Wanjala and colleagues reported psychological issues such as despair, anxiety, mood swings, low self-esteem, and melancholy. Their inability to accept their HIV diagnosis made it difficult for them to tell people about it, take their antiretrovirals as prescribed, and interact with the community.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] In another study, women with less education, who resided in rural areas, and who had limited access to healthcare facilities were less likely to report their HIV status.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] Gender inequality and power imbalances in relationships can also impede women's self-informing behaviour in Kenya.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] Several studies have explored the factors associated with HIV-related shame and stigma in Kenya, but few have specifically examined the determinants of shame in stigmatization among WLHIVs. By examining the determinants of shame within the context of the HIV Stigma Framework, this study aims to provide insights into the complex interplay between individual, interpersonal, and structural factors that contribute to the stigmatization and shame experienced by self-reported women living with HIV in Kenya. These findings can inform the development of multilevel interventions that address both the individual and societal drivers of shame, promoting greater resilience, self-acceptance, and overall well-being among this vulnerable population.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area\u003c/h2\u003e \u003cp\u003eKenya is located in the East African region. The country is organized into 8 regions, including the western region, which is under study. There are also 47 counties in the 8 regions. The Kenyan western region is located in the southwestern corner of the country, sharing borders with Lake Victoria to the south, where the Rift Valley region is located to the east and Uganda to the west. It forms an interlocking circle and is composed of many counties, including Kakamega, Bungoma, Busia, Vihiga and parts of Trans Nzoia and Siaya. The picture is beautiful - green scenery, little hills and plains that are cultivated to grow the main crops. In addition, it is famous because of its multifaceted cultural variation, sophisticated markets and flourishing towns. The scopes of importance to this region are the quiescent anchorage of Kisumu, Kakamega, and Eldoret.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSample Design and Study Population\u003c/h2\u003e \u003cp\u003eKDHS 2022 was drawn from the Kenya Household Master Sample Frame (K-HMSF), which was obtained from the 2019 Kenya Population and Housing Census[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The frame included 10,000 last places (LPEAs) selected with a systematic probability proportional to size. Using either the K-Means method or its variation K-Hierarchical method, the maximum number of clusters in rural and urban parts of the area was 1692 subclusters. The Epsom method of cluster selection, with a two-stage stratified sample design, was used. Household sampling was conducted in all selected clusters, with the principle of cluster division being 25 households from each cluster, resulting in data for 42,022 households. K-HMSFs were sampled from the 2019 Kenya Population and Housing Census. From this 10EA, which was randomly taken from different locations, the K-HMSFs were developed using subsample data. The residents of the 47 counties were divided into two parts, rural and urban gates, which ultimately had a total of 92 places according to the uniting factor[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The survey questions involved Mombasa County and Nairobi city, which are considered to be entirely urban regions. For a sample size of 42,300 households, a total of 1,692 clusters were established, 1,026 of which were rural and 666 of which were urban[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Two two-stage stratified sample designs based on cluster random selection of 1692 clusters were adopted. Regarding the sampling technique utilized, the sample clusters were randomly generated using an Epsom (equal probability sampling), K-HMSF. The door-to-door listing will be initiated in all the clusters, and 25 households will constitute a cluster. Subsidies were provided, and clusters with fewer than 25 members were customized for those neighborhoods. CAPI was the main tool within IPA (Interviewer's Assistance), which was utilized to establish clusters of 100 households in each required planning. The principle of not duplication was upheld by creating one enumeration district that was used for several enumeration segments.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003eFour questionnaires were used in KDHS 2022: Household, Man\u0026rsquo;s, Woman\u0026rsquo;s, and Biomarker. The survey questionnaires gathered rich information on household attributes, demographic issues, indicators of health, and anthropometry measurements [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In parallel, a Fieldworker Questionnaire was employed to provide an official portrait of the survey team. The questionnaires were translated into the national language 'Kiswahili' and were administered via a computer-assisted personal interview approach for more efficient data collection.\u003c/p\u003e \u003cp\u003e \u003cb\u003eVariable definitions.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eIn this study, two types of variables were included: the outcome variable and the predictor/exposure variables. The outcome variable of interest was feeling ashamed of HIV-positive status disclosure, which is binary (agreed to shame or disagreed to shame). The exposure variables in the study included whether the respondent was stigmatized, which was measured by 5 variables that were binary in nature (yes or no); people felt stigmatized because people talked badly; someone else disclosed their HIV status; they were verbally insulted, harassed or threatened; health care workers talked badly; and health care workers verbally abused the patients. Age category in 5-year groups (15\u0026ndash;19, 20\u0026ndash;24, 25\u0026ndash;29, 30\u0026ndash;34, 35\u0026ndash;39, 40\u0026ndash;44, 45\u0026ndash;49), residence type (rural or urban), and self-reported health status (very good, good, moderate or bad)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eThe statistical analysis included 332 women aged 15\u0026ndash;49 years whose test results indicated that they were HIV positive. The analysis considered the complex survey design, and weights were applied to ensure representativeness and to correct for nonresponse. A descriptive analysis of the outcome of the study with the predictor variables was carried out to generate the weighted frequencies and percentages. Binary logistic regression and multivariate logistic regression were performed, and the corresponding unadjusted odds ratios and adjusted odds ratios, respectively, were recorded. All the statistical analyses were conducted using STATA 17.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eTable 1 shows the association between the percentage of HIV-positive patients who felt ashamed\u0026nbsp;or\u0026nbsp;not ashamed because of their HIV status by selected background characteristics. Feeling ashamed among HIV-positive patients varied based on age, place of residence, health status, and negative social interactions. Younger HIV patients aged 15-19\u0026nbsp;years\u0026nbsp;were less likely to feel ashamed (21%), with 78.7% disagreeing with feeling ashamed, whereas those in the 45-49\u0026nbsp;years\u0026nbsp;age group showed higher levels of shame, with only 53.8% disagreeing.\u0026nbsp;Compared with urban\u0026nbsp;residents, rural residents\u0026nbsp;were more likely to feel ashamed, with 38.6% in rural areas agreeing with feeling ashamed versus 36% in urban areas.\u003c/p\u003e\n\u003cp\u003ePatients reporting excellent health\u0026nbsp;were more likely to feel\u0026nbsp;ashamed (47.2% agree) than those reporting moderate health (29.7% agree).\u0026nbsp;A total of 52.3% of the patients\u0026nbsp;with poor health status\u0026nbsp;agreed that they felt ashamed. Experiences related to HIV status also played a significant role: patients who did not face negative talk from others showed\u0026nbsp;greater\u0026nbsp;disagreement with feeling ashamed (69.5%), while those who faced negative talk had\u0026nbsp;greater\u0026nbsp;agreement (52%). Similarly, patients who did not experience verbal insults or harassment disagreed more with feeling ashamed (66.7%)\u0026nbsp;than did\u0026nbsp;those who did (46.6%).\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1: Descriptive results of HIV+ women who felt ashamed and\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003enot ashamed\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;because of their HIV\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003estatus according to\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;selected\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ebackground characteristics\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.291161178509533%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003edisagree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.251299826689774%\" colspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eagree\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e\u003cstrong\u003eN =332\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003en\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003eage in 5 year groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\" valign=\"bottom\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e78.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e21.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e50.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e49.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e60.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e39.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e65.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e34.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e66.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e33.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e40-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e64.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e35.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e45-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e53.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e46.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e71\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003etype of place of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eurban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e108\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003erural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e61.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e137\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e38.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e224\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003eself-reported health status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003every good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003egood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e62.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e37.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e132\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003emoderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e70.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e85\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e29.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e122\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003ebad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e47.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e52.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: people talk badly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e69.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e30.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e220\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e112\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: someone else disclosed the status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e68.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e31.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e235\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e47.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: verbally insulted/harassed/threaten\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e258\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e46.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e53.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e74\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: healthcare workers talked badly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e62.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e187\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e37.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e298\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e58.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e41.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: healthcare workers verbally abused\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e63.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e36.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e317\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"57.36568457538995%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e43.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.145580589254767%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.838821490467938%\"\u003e\n \u003cp\u003e56.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.412478336221837%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.091854419410746%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTable 2\u0026nbsp;shows the\u0026nbsp;odds ratios and P values\u0026nbsp;from\u0026nbsp;the bivariate analysis, with factors individually associated with shame highlighted. Significant factors associated with shame included negative social interactions, such as people talking badly due to HIV status, disclosure of HIV status by others, and verbal harassment or abuse. Patients who experienced negative talk due\u0026nbsp;to\u0026nbsp;their HIV status had significantly\u0026nbsp;greater\u0026nbsp;odds of feeling ashamed (OR=2.29,\u0026nbsp;95% CI:\u0026nbsp;1.43-3.66,\u0026nbsp;P=0.00). Similarly, those whose HIV status was disclosed by someone else were significantly\u0026nbsp;more likely to feel\u0026nbsp;ashamed (OR=2.52, 95% CI:\u0026nbsp;1.54-4.12;\u0026nbsp;P=0.00).\u003c/p\u003e\n\u003cp\u003eVerbal insults or harassment were also significantly associated with increased odds of feeling ashamed (OR=2.20, 95% CI:\u0026nbsp;1.29-3.77;\u0026nbsp;P=0.004). Additionally, negative behaviour by healthcare workers was a strong factor, with patients experiencing negative talk from healthcare workers showing significantly\u0026nbsp;greater\u0026nbsp;odds of shame (OR=2.81,\u0026nbsp;95% CI: 1.24-6.34, P=0.013) and those verbally abused by healthcare workers having even\u0026nbsp;greater\u0026nbsp;odds of feeling ashamed (OR=6.57,\u0026nbsp;95% CI: 1.82-23.74, P=0.004).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2: Bivariate\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eassociation\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;of shame among HIV+\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003epatients\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;by selected\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ebackground characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"686\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; UOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003eage in 5 year groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"31.632653061224488%\"\u003e\n \u003cp\u003e1.00 (1.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.034985422740526%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; 3.37 (0.68, 17.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;2.49 (0.53, 11.81)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.58 (0.38, 6.61)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.53\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.67 (0.42, 6.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e40-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e2.16 (0.54, 8.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e45-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e2.32 (0.58, 9.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003etype of place of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eurban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.00 (1.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003erural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e0.95 (0.62, 1.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003eself reported health status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003every good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.00 (1.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003egood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e0.82 (0.38, 1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.61\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003emoderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e0.60 (0.27, 1.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003ebad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.98 (0.79, 4.98)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003every bad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because hiv positive status: people talk badly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.00 (1.00,1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e2.29 (1.43, 3.66)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00\u003csup\u003e***\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: someone else disclosed the status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.00 (1.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026nbsp;2.52 (1.54, 4.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.00\u003csup\u003e***\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: verbally insulted/harassed/threaten\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.00 (1.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e2.20 (1.29, 3.77)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003csup\u003e***\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: healthcare workers talked badly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.00 (1.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e2.81 (1.24, 6.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.013**\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: healthcare workers verbally abused\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e1.00 (1.00, 1.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"37.02623906705539%\" colspan=\"2\"\u003e\n \u003cp\u003e6.57 (1.82, 23.74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.004\u003csup\u003e***\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"52.332361516034986%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"31.632653061224488%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"5.393586005830904%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"10.641399416909621%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u0026nbsp;***p \u0026lt; 0.01, ** p \u0026lt; 0.05, UOR: Unadjusted odds ratio\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 presents\u0026nbsp;the\u0026nbsp;results from a multiple logistic regression model to establish factors associated with shame among HIV-positive women. The only factor found to be significantly related to feelings of shame was the disclosure of HIV status by someone else. Women whose HIV status was disclosed by someone else had significantly\u0026nbsp;greater\u0026nbsp;odds of feeling ashamed\u0026nbsp;than did\u0026nbsp;their counterparts whose status was not disclosed by others. (AOR=1.98,\u0026nbsp;95% CI: 1.08-3.65, P=0.028).\u003c/p\u003e\n\u003cp\u003eAlthough not statistically significant, other factors\u0026nbsp;were associated with\u0026nbsp;increased odds of\u0026nbsp;experiencing\u0026nbsp;shame. For example, women aged 20-24\u0026nbsp;years\u0026nbsp;had\u0026nbsp;greater\u0026nbsp;odds (AOR=3.65,\u0026nbsp;95% CI: 0.66-20.14, P=0.24), and those who experienced verbal abuse from healthcare workers also had\u0026nbsp;greater\u0026nbsp;odds (AOR=3.73,\u0026nbsp;95% CI:\u0026nbsp;0.84-16.56, P=0.08).\u003cstrong\u003e\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Logistic Regression Analysis of Factors Associated with Agreement to Shame among Self-Reported HIV-Diagnosed Patients in Kenya\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"624\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003eCharacteristics\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eAOR (95% CI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\" rowspan=\"2\" valign=\"bottom\"\u003e\n \u003cp\u003e\u003cstrong\u003eP- Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge in 5-year groups\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e15-19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e20-24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e3.65 (0.66,20.32)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e25-29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e2.79 (0.54, 14.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e30-34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1.75 (0.39, 7.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e35-39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1.89 (0.44, 8.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e40-44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e2.23 (0.52, 9.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e45-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e2.41 (0.56, 10.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.24\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003etype of place of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eurban\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003erural\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e0.99 (0.60, 1.63)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.96\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003eself-reported health status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003every good\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003egood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e0.84 (0.38, 1.87)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.68\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003emoderate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e0.56 (0.24, 1.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003ebad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1.73 (0.67, 4.48)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: someone else disclosed the status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1.98 (1.08, 3.65)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.028\u003csup\u003e**\u003c/sup\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: verbally insulted/harassed/threaten\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1.30 (0.65, 2.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: healthcare workers talked badly\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1.09 (0.39, 3.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003e\u003cstrong\u003ethings happened because HIV positive status: healthcare workers verbally abused\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eno\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"62.01923076923077%\"\u003e\n \u003cp\u003eyes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.846153846153847%\"\u003e\n \u003cp\u003e3.73 (0.84, 16.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.134615384615385%\"\u003e\n \u003cp\u003e0.08\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote: \u0026nbsp;***p \u0026lt; 0.01, ** p \u0026lt; 0.05, AOR: adjusted odds ratio\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of this study revealed that more than one-third of the respondents agreed to have experienced shame because of their HIV-positive status. A slightly greater proportion of rural dwellers reported shame than did their urban counterparts. This proportion is higher than what was reported from a previous study in Nigeria, where 29% of respondents reported being ashamed because of their positive HIV status. This study, like the current study, also showed that more rural than urban dwellers reported shame about their HIV-positive status [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], most likely because discriminatory attitudes towards HIV are more prevalent in rural areas, as reported in other studies [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These studies stated that urban dwellers are more exposed to education about HIV through mass media and interaction with health personnel, thereby making them less discriminatory than their rural counterparts [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The high proportion of HIV-positive patients who reported shame, probably because of prevalent discriminatory attitudes, has serious implications for every level of control of the disease [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e In this study, \u0026ldquo;people talking badly about the respondent\u0026rsquo;s HIV status\u0026rdquo;, \u0026ldquo;someone else disclosing status\u0026rdquo;, \u0026ldquo;verbal insults or harassment by members of their community\u0026rdquo; and \u0026ldquo;health workers talking badly or harassing the respondents\u0026rdquo; were all significantly associated with reporting shame. Women who were verbally insulted, harassed, or threatened because of their HIV-positive status were more likely to report shame than those who were not. This stigma and discrimination provide needless barriers across HIV prevention, testing, and treatment cascades. This is consistent with findings from previous studies where similar factors were associated with stigma and shame [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This study suggests a need for targeted interventions aimed at improving awareness and education about HIV, especially in rural communities of Kenya. This will result in reduced discriminatory attitudes towards the disease, thereby resulting in reduced shame and increased willingness to test for HIV and, in turn, access antiretroviral therapy without fear of experiencing shame. There will also be a need for training and retraining health workers in the areas of patient rights, dignity, and confidentiality. The management of health institutions and the National Medical Council should establish and implement disciplinary measures for health workers who verbally abuse or stigmatize HIV patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of this study highlight the burden and determinants of shame among women living with HIV in Kenya, particularly among rural dwellers who experience higher levels of stigma than their urban counterparts. Key factors contributing to this shame include community gossip, unauthorized disclosure of status, verbal harassment, and negative treatment by health workers. Addressing these issues is crucial for mitigating stigma, improving HIV testing rates, and ensuring better access to treatment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDS Acquired immune deficiency syndrome\u003c/p\u003e\n\u003cp\u003eHIV Human Immune Virus\u003c/p\u003e\n\u003cp\u003eART Antiretroviral therapy\u003c/p\u003e\n\u003cp\u003ePLWHA People living with HIV/AIDS\u003c/p\u003e\n\u003cp\u003e2022 KDHS Kenya Demographic and Health Survey data 2022\u003c/p\u003e\n\u003cp\u003eKNBS Kenya National Bureau of Statistics\u003c/p\u003e\n\u003cp\u003eMoH Ministry of Health\u003c/p\u003e\n\u003cp\u003eDHS Demographic and Health Survey\u003c/p\u003e\n\u003cp\u003eK-HMSF Kenya Household Master Sample Framework\u003c/p\u003e\n\u003cp\u003eUSAID United States Agency for International Development\u003c/p\u003e\n\u003cp\u003eKPHC Kenya Population and Housing Census\u003c/p\u003e\n\u003cp\u003ePMTCT Prevention of Mother-to-Child Transmission\u003c/p\u003e\n\u003cp\u003eUOR Unadjusted odds ratio\u003c/p\u003e\n\u003cp\u003eAOR Adjusted Odds Ratios\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was required for this study because it utilized secondary data. The authors obtained permission to use the secondary data from the DHS Program websitehttps://www.dhsprogram.com/data/available-datasets.cfm. The Demographic and Health Survey also ensured that all participants provided informed verbal consent to participate in the study, and for minors, their parents or guardians consented on their behalf.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study can be accessed online through the DHS website upon request (https://dhsprogram.com/).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors\u0026nbsp;declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere was no\u0026nbsp;funding for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eII\u003c/strong\u003e conceptualized and drafted the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSN, LNO,\u003c/strong\u003e and \u003cstrong\u003eII\u003c/strong\u003e performed the analyses and interpreted the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAM, LNO, JMA, HO\u003c/strong\u003e and \u003cstrong\u003eII\u003c/strong\u003e wrote the\u0026nbsp;Introduction\u0026nbsp;and\u0026nbsp;Methodology\u0026nbsp;sections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGNB\u003c/strong\u003e wrote the discussion section and conclusion of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003cstrong\u003eBWS\u003c/strong\u003e reviewed the first draft\u0026nbsp;of the manuscript\u003c/p\u003e\n\u003cp\u003eAll authors reviewed and approved the final draft of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge\u003cstrong\u003e\u0026nbsp;t\u003c/strong\u003ehe Kenya National Bureau of Statistics (KNBS) and the Ministry of Health (MoH) of Kenya for conducting the 2022 KDHS and disseminating the results and data online for accessibility and reuse. This was\u0026nbsp;supported by\u0026nbsp;funding provided by the United States Agency for International\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eDevelopment (USAID) and the Global Fund. The ICF also provided technical assistance through the DHS Program.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKumah E, Boakye DS, Boateng R, Agyei E. Advancing the Global Fight Against HIV/Aids: Strategies, Barriers, and the Road to Eradication. Ann Glob Health. 2023;89(1).\u003c/li\u003e\n \u003cli\u003eGlobal Health Policy. KFF. 2023 [cited 2024 May 7]. The Global HIV/AIDS Epidemic. Available from: https://www.kff.org/global-health-policy/fact-sheet/the-global-hiv-aids-epidemic/#endnote_link_594185-40\u003c/li\u003e\n \u003cli\u003eMoyo E, Moyo P, Murewanhema G, Mhango M, Chitungo I, Dzinamarira T. Key populations and Sub-Saharan Africa\u0026rsquo;s HIV response. Vol. 11, Frontiers in Public Health. 2023.\u003c/li\u003e\n \u003cli\u003eAndrews C, Reuter TK, Marsh L, Velazquez JM, Jaoko W, Jolly P. Intimate partner violence, human rights violations, hhr_final_logo_alone.Indd 1 and hiv among women in Nairobi, Kenya. Health Hum Rights. 2020;22(2).\u003c/li\u003e\n \u003cli\u003eZegeye B, Adjei NK, Ahinkorah BO, Tesema GA, Ameyaw EK, Budu E, et al. HIV testing among women of reproductive age in 28 sub-Saharan African countries: a multilevel modelling. Int Health. 2023;15(5).\u003c/li\u003e\n \u003cli\u003eKimanga DO, Ogola S, Umuro M, Ng\u0026rsquo;ang\u0026rsquo;a A, Kimondo L, Murithi P, et al. Prevalence and incidence of HIV infection, trends, and risk factors among persons aged 15-64 years in Kenya: Results from a nationally representative study. J Acquir Immune Defic Syndr (1988). 2014;66(SUPPL. 1).\u003c/li\u003e\n \u003cli\u003eRamjee G, Daniels B. Women and HIV in Sub-Saharan Africa. Vol. 10, AIDS Research and Therapy. 2013.\u003c/li\u003e\n \u003cli\u003eStangl AL, Earnshaw VA, Logie CH, Van Brakel W, Simbayi LC, Barr\u0026eacute; I, et al. The Health Stigma and Discrimination Framework: A global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Med. 2019;17(1).\u003c/li\u003e\n \u003cli\u003eWanjala SW, Nyongesa MK, Mapenzi R, Luchters S, Abubakar A. A qualitative inquiry of experiences of HIV-related stigma and its effects among people living with HIV on treatment in rural Kilifi, Kenya. Front Public Health. 2023;11.\u003c/li\u003e\n \u003cli\u003eStangl AL, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? Vol. 16, Journal of the International AIDS Society. 2013.\u003c/li\u003e\n \u003cli\u003eNabunya P, Namuwonge F. HIV-Related Shame, Stigma and the Mental Health Functioning of Adolescents Living with HIV: Findings from a Pilot Study in Uganda. Child Psychiatry Hum Dev. 2023;54(6).\u003c/li\u003e\n \u003cli\u003eDolezal L, Lyons B. Health-related shame: An affective determinant of health? Med Humanit. 2017;43(4).\u003c/li\u003e\n \u003cli\u003eHutchinson P, Dhairyawan R. Shame and HIV: Strategies for addressing the negative impact shame has on public health and diagnosis and treatment of HIV. Bioethics. 2018;32(1).\u003c/li\u003e\n \u003cli\u003eBennett DS, Traub K, Mace L, Juarascio A, O\u0026rsquo;Hayer CV. Shame among people living with HIV: A literature review. AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV. 2016;28(1).\u003c/li\u003e\n \u003cli\u003eLi Z, Morano JP, Khoshnood K, Hsieh E, Sheng Y. HIV-related stigma among people living with HIV/AIDS in rural Central China. BMC Health Serv Res. 2018;18(1).\u003c/li\u003e\n \u003cli\u003eHussein J, Ferguson L. Eliminating stigma and discrimination in sexual and reproductive health care: a public health imperative. Vol. 27, Sexual and Reproductive Health Matters. 2019.\u003c/li\u003e\n \u003cli\u003eAkatukwasai C, Getahun M, Ayadi AME, Namanya J, Maeri I, Itiakorit H, et al. Dimensions of HIV-related stigma in rural communities in Kenya and Uganda at the start of a large HIV \u0026ldquo;test and treat\u0026rdquo; trial. PLoS One. 2021;16(5 May 2021).\u003c/li\u003e\n \u003cli\u003eChan KY, Stoov\u0026eacute; MA, Reidpath DD. Stigma, social reciprocity and exclusion of HIV/AIDS patients with illicit drug histories: A study of Thai nurses\u0026rsquo; attitudes. Harm Reduct J. 2008;5.\u003c/li\u003e\n \u003cli\u003eChambers LA, Rueda S, Baker DN, Wilson MG, Deutsch R, Raeifar E, et al. Stigma, HIV and health: A qualitative synthesis. Vol. 15, BMC Public Health. 2015.\u003c/li\u003e\n \u003cli\u003eH G, PE J, T J, R G, W J, LA P. Characteristics Associated with Disclosure Status to Sexual Partners among Kenyan Women. J HIV AIDS. 2019;5(2).\u003c/li\u003e\n \u003cli\u003eAdekoya P, Lannap FD, Ajonye FA, Amadiegwu S, Okereke I, Elochukwu C, et al. Experiences of stigmatization and discrimination in accessing healthcare services among people living with HIV (PLHIV) in Akwa Ibom State, Nigeria. HIVAIDS Auckl NZ. 2024 Feb 19;16:45\u0026ndash;58.\u003c/li\u003e\n \u003cli\u003e\u0026nbsp;Diress GA, Ahmed M, Linger M. Factors associated with discriminatory attitudes towards people living with HIV among adult population in Ethiopia: analysis on Ethiopian demographic and health survey. SAHARA J J Soc Asp HIVAIDS Res Alliance. 2020 Dec;17(1):38\u0026ndash;44.\u003c/li\u003e\n \u003cli\u003eEgbe TO, Nge CA, Ngouekam H, Asonganyi E, Nsagha DS. Stigmatization among People Living with HIV/AIDS at the Kumba Health District,\u0026nbsp;Cameroon. J Int Assoc Provid AIDS Care. 2020;19:2325958219899305.\u003c/li\u003e\n \u003cli\u003eHutchinson P, Dhairyawan R. Shame and HIV: Strategies for addressing the negative impact shame has on public health and diagnosis and treatment of HIV. J Bioeth. 2017 Aug 23;32.\u003c/li\u003e\n \u003cli\u003eValencia-Garcia D, Rao D, Strick L, Simoni JM. Women\u0026rsquo;s experiences with HIV-related stigma from health care providers in Lima, Peru: \u0026ldquo;I would rather die than go back for care.\u0026rdquo; Health Care Women Int. 2017 Feb;38(2):144\u0026ndash;58.\u003c/li\u003e\n \u003cli\u003eKNBS and ICF. 2023. Kenya Demographic and Health Survey 2022: Volume 1. Nairobi, Kenya, and Rockville, Maryland, USA: KNBS and ICF.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"HIV stigma, Human immunodeficiency virus, HIV among women, Shame, Kenya","lastPublishedDoi":"10.21203/rs.3.rs-4660307/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4660307/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose: \u003c/strong\u003eHIV/AIDS is a highly prevalent infectious diseasemostly in sub-Saharan Africa,and several strategies have been put in place to reduce its spread. This study aimed to assess the determinants of shame in the stigmatization of self-reported women with HIV in Kenya.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The data used in this study were obtained from the 2022 KDHS. The statistical analysis included 332 women aged 15-49 years who reported that their test results indicated that they were HIV positive, and the analysis considered the complex survey design; hence, weights were applied. All the statistical analyses were conducted using STATA 17.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eWomen whose HIV status was disclosed by someone else (AOR=1.98, 95% CI: 1.08-3.65, P=0.028) had significantly greater odds of feeling ashamed than did their counterparts whose status was not disclosed.\u003c/p\u003e\n\u003cp\u003eAlthough not statistically significant, beingaged 20-24 years (AOR=3.65, 95% CI: 0.66-20.14, P=0.24) and experiencingverbal abuse from healthcare workers (AOR=3.73, 95% CI: 0.84-16.56, P=0.08) werealso factors associated withincreased odds of experiencingshame.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e Factors contributing to shame among HIV-positive women include community gossip, unauthorized disclosure of status, verbal harassment, and negative treatment by health workers; addressing these problems is very important for addressing HIV-related stigma, improving HIV testing rates, and ensuring better access to treatment, especially among women living in rural areas.\u003c/p\u003e","manuscriptTitle":"Determinants of shame in the stigmatization of self-reported women with human immunodeficiency virus in Kenya; A secondary analysis of 2022 Kenya demographic and health survey data","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-24 08:41:30","doi":"10.21203/rs.3.rs-4660307/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5899e086-e760-4712-ae40-47d678f02ae1","owner":[],"postedDate":"July 24th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-25T23:08:28+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-24 08:41:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4660307","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4660307","identity":"rs-4660307","version":["v1"]},"buildId":"ehx78VzkSd0WSzXnipQa-","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}