Long-term trends in HIV-related stigma among older adults with and without HIV: a cohort study from Mbarara, Uganda

Perceived HIV stigma is a persistent challenge, contributing to reduced antiretroviral therapy adherence among people with HIV. Although perceived stigma declined with treatment rollout, it is unknown if that trend has continued, particularly among the growing population of older adults with HIV in sub-Saharan Africa.

We analyzed data from 6 waves of data collection over 9 years in a cohort of older adults with and without HIV in Uganda. Participants completed a standardized 15-item perceived stigma questionnaire at each visit. We fitted generalized estimating equations to characterize trends in stigma over time, stratified by HIV serostatus.

We analyzed follow-up data on 271 individuals with a median duration of 9 years (interquartile range [IQR]: 8-9). Approximately 51% were people with HIV, 47% were women, and the median age was 51 years (IQR: 48-55) at baseline. Compared to 2015, perceived stigma decreased among people with HIV through 2018 with further declines up to 2024 (p < .05 for all comparisons). By contrast, among people without HIV, after a decrease from 2015 to 2018 (p < .05), perceived stigma increased substantially, such that levels in 2022 were similar to 2015 (p = .92).

Perceived stigma has decreased over the past decade among older people with HIV but remains at a similar level in the early 2020s as in 2015 among those without HIV in Uganda. These findings highlight the importance of maintaining HIV sensitization efforts in the general population, even in an era with decreasing HIV-related deaths.