Programs Designed to Promote HIV Testing May Worsen Misinformation, Stigma

A community-based program on HIV/AIDS was found to have inadvertently increased misinformation surrounding HIV transmission and worsened HIV-related stigma, resulting in decreased rates of HIV testing, according to study findings published in the Journal of Development Economics.

Researchers conducted a randomized controlled trial to evaluate the effect of an HIV/AIDS program on HIV testing rates in Mozambique, Africa. The program was designed to promote HIV testing by improving knowledge of HIV/AIDS and reducing stigmatizing attitudes.

During a period of initial program observation from baseline (2017-2018) until an endline survey (2019), the researchers gathered information on self-reported HIV testing from 76 communities consisting of 3700 households. They randomly assigned half of the 76 communities to receive the program and the other half to a control group.

Individuals within the communities assigned to the program group were visited in their homes and received complementary interventions in community and school settings to encourage HIV testing. The interventions included the dissemination of HIV-related information, alleviating concerns about HIV-related stigma, and providing financial incentives and coupons for HIV testing. The primary outcome was the number of coupons redeemed within 14 days after completion of the endline survey, as well as rates of school attendance among children in the communities. 

The endline survey revealed that the program did not improve overall knowledge of HIV/AIDS but had increased misinformation, possibly by reinforcing beliefs in various myths about HIV transmission. Additionally, the program exacerbated HIV-stigmatizing attitudes.

Because the HIV/AIDS program had the opposite effect on HIV testing than what was intended, individuals within households assigned to receive the program were less likely to undergo HIV testing compared with those within households assigned to the control group.

Immediately following completion of the endline survey, the researchers randomly assigned households to receive 1 of 5 “minitreatments,” defined as interventions to counter the misinformation and stigma caused by the HIV/AIDS program. Compared with a control household that received no minitreatment, households that received corrective minitreatments demonstrated significantly higher HIV testing rates.

Researchers were unable to determine the reasons for which the community program led to increases in misinformation and stigma surrounding HIV, including actions of the staff, the type of information conveyed, and responses to the information received. They suggested, however, that if it had been known in the community that home visits by program staff were targeted toward households with HIV-infected individuals, this may have inadvertently worsened HIV-related stigma in the community.

“Our results point to a thus-far neglected possibility: programs seeking to raise HIV testing may fail due to deficiencies in information provision and in counteracting HIV-related stigma,” the researchers noted. “These findings highlight the importance of improving knowledge and alleviating stigma concerns when promoting HIV testing,” the researchers concluded.