Results of the people living with HIV stigma index in lao PDR: Documenting the HIV stigma and discrimination situation in the country and disentangling the layers of stigma in marginalized populations

Background: HIV-related stigma and discrimination (S&D) pose threats to the prevention, treatment, and control of HIV/AIDS in Laos. Limited knowledge exists about the prevalence and nature of these phenomena nationally and about how S&D experiences differ in marginalized groups of Lao society. Methods: Using the People Living with HIV (PLHIV) Stigma Index questionnaire, 305 PLHIV accessing healthcare in 3 regions of Laos from January to February 2012 were surveyed about experienced S&D events over the previous year. Principal component analysis (PCA) served to develop a multidimensional measure of S&D. Zero-inflated Poisson (ZIP) regressions measured the impact of selected socio-demographic and clinical characteristics on the risk of S&D events. Results: High proportions of PLHIV suffer S&D in their community, family, workplace, and own psyche (self-stigma). PCA resulted in a 13-item measure of S&D composed of 3 subscales representing social stigma, self-stigma, and disclosure concerns. Cronbach's alpha of internal reliability was 0.72 for the overall measure and exceeded 0.60 for two of the three stigma subscales. ZIP models found that PLHIV had significantly higher risks of stigma events if they were female, transgender, 16-29 years old, ethnic minorities, undereducated, inhabitants of the southern region, sexually active, migrant workers, unhealthy, not taking medications against opportunistic infections, or not knowledgeable of the laws protecting their rights. Conclusions: High levels of HIV-S&D in Laos are accompanied by the layering of stigmas in marginalized populations. This suggests that interventions designed to mitigate the negative impact of S&D need to be targeted for each specific subgroup of PLHIV.