HIV-related stigma trends in the general population of India during an era of antiretroviral treatment expansion, 2005-16

Background In India, which has the world's third-largest HIV epidemic, the extent to which levels of HIV-related stigma have changed during an era of ART scale-up is unknown. Methods We analyzed data from the 2005-06 and 2015-16 National Family Health Surveys (NFHS) to estimate trends in two stigma domains among people in the general population: desires for social distance from people living with HIV (ie, unwillingness to interact) and fear of serostatus disclosure in the case of a hypothetical HIV infection. We fitted multivariable linear probability models to the data with year of NFHS as the explanatory variable and alternately specifying fear of disclosure or desires for social distance as the dependent variable. Analyses were stratified by sex, state, and high vs low HIV prevalence states. Results We included data on 172 795 women and 159 194 men. Desires for social distance declined in 2015-16 compared with 2005-06 (38% in 2015-16 vs 43% in 2005-06; adjusted b=-0.046; 95% confidence interval (CI= -0.049 to -0.043; P<0.001) but fear of serostatus disclosure increased (31% in 200506 vs 37% in 2015-16; adjusted b=0.058; 95% CI=0.055-0.062; P< 0.001). Declines in social distancing were more pronounced among men and in high HIV prevalence states. Increased fear of serostatus disclosure was greater among women and in high HIV prevalence states. There was significant variability in trends disaggregated by state. Conclusions During the first decade of ART scale-up in India, fear of HIV serostatus disclosure in the general population increased despite a decline in desires for social distance.