Associations Between HIV-Related Stigma, Trust, and Testing Behaviors Among the General U.S. Adult Population.

Abstract

HIV testing is essential to achieving the 95-95-95 targets, yet lifetime HIV testing rates in the United States fall below established guidelines. Building on similar healthcare contexts where stigma hinders access and trust mitigates its negative effect, this exploratory study examined the relationship between HIV-related stigma (HRS) and testing behavior, focusing on the role of trust in healthcare providers (HCPs). We used data from the 2022 General Social Survey, a nationally representative sample of the general population. HRS was evaluated across three domains: perceived social discrimination towards people living with HIV (PLWH), avoidance due to unfounded fear of transmission, and moral judgement. Weighted stratified logistic regression was employed to examine how the relationship between HRS and testing behavior varied across different levels of trust in HCPs. Among participants with low trust in HCPs, the avoidance of PLWH due to unfounded fears was associated with lower odds of undergoing HIV testing. In the high trust group, none of the HRS domains were associated with HIV testing; instead, testing was linked to the individual's engagement in HIV-risk behaviors. Our findings reveal a complex interplay between HRS, trust, and testing behavior, highlighting the need for collective action to address misconceptions about HIV transmission and promote awareness of risk behaviors, with concurrent efforts to foster trust in HCPs.