Study report: the people living with HIV Stigma Index 2.0 in six districts of South Africa 2020-2021

Stigma and discrimination against PLHIV remain some of the key barriers to the effective prevention and management of HIV in Africa. Similarly, the outbreak of Coronavirus disease 2019 (COVID-19) is expected to put key and vulnerable groups-including PLHIV-at heightened risk, given that containment measures to slow the pandemic including lockdowns and disruption of basic services are already being seen to exacerbate existing economic and social inequalities. Moreover, with the onset of the COVID-19 pandemic, fear of infection also increases social exclusion and stigmatisation. The Stigma Index was developed by various international organisations to assess different forms of stigma and discrimination experienced by PLHIV. For the first time in South Africa, this study made use of the Stigma Index 2.0-an updated version of the Stigma Index that reflects shifts in the HIV epidemic and the global response to HIV. Making use of the Stigma Index 2.0, we aimed to measure the levels of stigma and discrimination experienced by PLHIV, as well as stigma and discrimination attached to TB, COVID-19, disability, sex work, sexual orientation and gender identity (SOGI), and cyberbullying. his Stigma Index 2.0 was implemented in six districts across the provinces of KwaZulu-Natal, Mpumalanga, and the Free State. The districts selected were identified based on the need to have both urban and rural districts included in the study. For each of the provinces, one urban and one rural district were purposefully selected. This study included PLHIV aged 15 years and older who were linked to an organisation, including those attending primary healthcare centres, home-based care organisations, community-based organisations (CBOs), and non-governmental organisations (NGOs), to access support or care related to HIV. Stratified purposeful sampling (by district) with equal allocation was used in each province to enable reporting at the district level. The Stigma Index 2.0 responses and consent were recorded on tablets. Data collection was conducted using side-by-side interviewing. An overall final sample of 3 716 participants self-reported as living with HIV; 73.4% (n=2 677) were female and 26.6% (n=972) were male.