Conceptualizing HIV-Associated Stigma and Exploring the Correlates of HIV Testing Behaviors for Incarcerated Men in North Carolina

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  • March 22, 2019
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  • Ochtera, Rebecca Davis
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • National HIV testing guidelines recommend routine testing for all individuals and annual testing for high-risk individuals. Incarcerated men are at high risk for HIV but little is known regarding their HIV testing behaviors. Evidence suggests HIV-associated stigma may influence HIV testing. However, the ability to assess the relationship between stigma and HIV testing is hindered by the lack of appropriately designed stigma measures. Study 1 presents a theoretically based conceptual model of the stigma process, including proxies of enacted stigma, and measures developed to test conceptual model components. Utilizing data from a sample of 1,000 inmates, Classical Test Theory and Structural Equation Modeling determined independence, reliability, and validity of these measures as well as accuracy of the model to illustrate the stigma process. Results also showed empirical support for the proposed conceptual model. Study 2 utilized nested model binary and multinomial logistic regression to explore correlates of HIV testing, including stigmatizing attitudes and beliefs, for 819 incarcerated men in North Carolina. History and recentness of HIV testing were assessed. Eighty percent of the sample had ever tested for HIV and, of those, 36% reported recent testing. Results generally indicated significantly higher odds of ever HIV testing with Black race, education beyond high school, prison recidivism, and higher HIV knowledge. Blacks were more likely to have ever as well as recently tested; those with higher education and greater HIV knowledge were more likely to have non-recently tested. Overall, stigmatizing attitudes were not found to be related to HIV testing behaviors. These findings suggest general HIV-associated stigmatizing attitudes and beliefs may not play an important role in inmates' decisions regarding if and when to seek testing for HIV. Based on study results, interventions to increase HIV testing for this population should address HIV-associated transmission knowledge, target white men, and be tailored to reach those with lower education levels. The prison setting is an important venue for encouraging HIV testing; more research is needed to determine the association between other structural and contextual variables and HIV testing for this population.
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  • ... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Public Health (Health Behavior and Health Education).
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  • Golin, Carol E.
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