Association between HIV knowledge and stigmatizing attitudes towards people living with HIV in Afghanistan: findings from the 2015 Afghanistan Demographic and Health Survey

Background: Afghanistan has witnessed a dramatic increase in HIV infections. Public health officials have responded with campaigns to educate the public about HIV prevention and transmission. We examine the association between HIV prevention and transmission knowledge and stigma towards people living with HIV (PLHIV) in Afghanistan. Methods: We conducted a secondary analysis of cross-sectional data (n=11 930) from the 2015 Afghanistan Demographic and Health Survey. Hierarchical linear regression analysis was used to examine the effects of accurate HIV knowledge related to safer sex and local misconceptions about the virus's transmission (e.g. mosquitos and witchcraft) on two stigma outcomes, namely, stigma towards public others with HIV (teachers and food vendors) and stigma towards close family members with HIV. Results: Stigmatizing attitudes were highly prevalent and HIV knowledge varied widely. Multivariate analyses show that correct knowledge related to local misconceptions about HIV prevention and transmission is significantly associated with lower stigma towards public others (Delta R-adjusted(2)=0.07); however, knowledge had little and contradictory influence in the model predicting stigma towards close family members with HIV (Delta R-adjusted(2)=0.005). Conclusions: These findings suggest that it would be worthwhile designing interventions that dispel local misconceptions about HIV. This may be helpful in reducing stigma towards PLHIV in public positions but not towards family members, which calls for alternative strategies for reducing HIV-related stigma.