Prevalence and predictors of HIV-related stigma among institutional- and community-based caregivers of orphans and vulnerable children living in five less wealthy countries

Background. In the face of the HIV / AIDS epidemic that has contributed to the dramatic increase in orphans and abandoned children (OAC) worldwide, caregiver attitudes about HIV is one attribute that may affect caregiving. Little research has considered the caregiving implications of individual attributes; this paper will describe HIV-related stigma among caregivers of OAC in 5 less wealthy nations. Methods. Caregiver characteristics (1,480 community- and 192 institution-based caregivers) are described using means and standard deviations (continuous variables) and percentages (categorical variables). Logistic regression models were fit, both for the full sample and separately for community- and institution-based caregivers, to explore predictors of HIV acceptance. Results. Approximately 80% of both community- and institution-based caregivers were female; and 84% of institution-based caregivers, compared to 66% of community-based caregivers, said that they would be willing to care for a relative with HIV. In a multivariable model predicting willingness to care for an HIV-infected relative, being an institution-based caregiver was associated with greater willingness (less stigma) than community-based caregivers. Decreased willingness was reported by older respondents; willingness increased with greater formal education. Adjusted models predicting willingness to allow one's child to play with an HIV-infected child are also considered. Conclusions. OAC already face stigma as a result of their orphaned or abandoned status; the addition of HIV-related stigma represents a double burden for these children. Further research on caregivers attributes and implications of stigma for child development will be critical as the policy community responds to the global HIV / AIDS orphan crisis.