208694 Analyzing shame and blame: Correlates of HIV-related stigma in a population-based survey in Malawi

Monday, November 9, 2009

Alisha H. Creel, PhD , Department of Preventive Medicine and Biometrics, Uniformed Services University of the Health Sciences, Bethesda, MD
Glory Mkandawire , Malawi BRIDGE Project, Lilongwe, Malawi
Lisa K. Folda, MHS , Johns Hopkins University Center for Communication Programs, Baltimore, MD
Jane W. Brown, MPH , Johns Hopkins University Center for Communication Programs, Baltimore, MD
Kirsten Böse, MHS , Center for Communication Programs, Johns Hopkins University, Baltimore, MD
Rajiv N. Rimal, PhD , Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: Blame and shame have been validated as distinct measures of HIV-related stigma (Nyblade and MacQuarrie, 2006; Creel et al., 2008). This study looks at correlates of blame and shame in a population-based survey in Malawi.

Methods: A household survey (N=966) using stratified random sampling was conducted in four districts in Malawi. Multivariate linear regression was used to look at demographic and psychosocial correlates of blame and shame.

Results: Both shame and blame were associated with low HIV-related knowledge and negative attitudes about the role of condoms in a relationship. Blame was associated with lower perceived susceptibility to HIV, higher perceived severity of HIV, higher resentment toward people with HIV (feeling they had too much power and attention in society), and being married. Shame was associated with both fear of HIV transmission through casual contact and perceived severity and was lower in people who had a relative with HIV or who owned a radio.

Conclusions: While blame and shame have common correlates, differences point to distinct underlying causes and solutions. Blame is related to social distancing of people with HIV (lower perceived risk, higher resentment) and negative views of the role of condoms in a relationship, such as seeing them as an indicator of mistrust or infidelity. Shame, on the other hand, appears to be related more to fear and uncertainty about HIV, reduced when one has social contact with people with HIV and more connection to the outside world through communication channels. Implications for interventions will be featured.

Learning Objectives:
Differentiate between HIV-related shame and blame and their correlates. Formulate intervention responses addressing both shame and blame.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Involved in data collection activities, conducted data analysis, wrote abstract.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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