Proximate Context of HIV Stigma and Its Association with HIV Testing in Sierra Leone: A Population-Based Study

The extent to which HIV stigma at the community level remains a barrier to greater uptake in HIV testing services is poorly understood. We used nationally representative data from the 2008 Sierra Leone Demographic and Health Survey. The primary outcome was HIV testing (past 12 months). Our explanatory variable was HIV stigmatizing attitudes (5-item scale). After multivariable adjustment, HIV testing had an inverse association with HIV stigmatizing attitudes measured at the individual [adjusted odds ratio (AOR) 0.94; 95 % CI 0.87-1.01] and community level (AOR 0.70; 95 % CI 0.58-0.85). HIV stigma had a stronger negative association with HIV testing when modeled at the community rather than individual level.