Stigma Related to Fear and Shame Restricts Access to HIV Testing and Treatment in Tanzania

Background: Tanzania is one of 15 nations that share 75% of the HIV burden in sub-Saharan Africa, with a national prevalence of 5.3% and prevalence rates as high as 30% in special populations. Knowledge about HIV infection, testing, and treatment is low, especially in younger populations, suggesting a need for effective HIV educational programs. We sought to understand the impact of HIV-related stigma and gender roles in HIV education and knowledge in educational programs and explored methodologies that effectively incorporate culturally competent approaches to reduce stigma in HIV education programs. Methods: Literature searches were conducted in multiple databases including the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Academic Search Complete, and the U.S. National Library of Medicine through the National Institutes of Health (Medline/PubMed). The search terms were structured to include all text of each article rather than restricting the search to titles or keywords. While these search criteria resulted in identification of 45 peer-reviewed articles, the inclusion criteria (HIV prevention, community education, HIV knowledge and stigma) led to the exclusion of all except 20 articles. Their findings are described here. Results: Attitudes of blame, fear of people on antiretroviral therapy spreading the disease, and an acceptance of a positive HIV status as punishment for sin were identified as barriers to testing. Cultural norms/perceptions and gender power dynamics were key components in creating culturally competent models that empower women to be tested and disclose their status. Community-level awareness and increased opportunities to interact with people living with HIV/AIDS were used successfully to reduce stigma among younger populations. Conclusions: Community-based programs partnered with religious organizations were effective in disseminating HIV education and can be used as a strategy for reducing shame-based stigma based upon misconceptions and popular beliefs. Stigma can also be reduced by increasing HIV knowledge with an appropriate sociocultural framework. We propose targeting community and religious leaders using train-the-trainer models as a means to improve HIV education and reduce stigma, especially within high-risk