Relationship between Knowledge of Someone Infected With HIV/AIDS and HIV Stigma: A Moderated Mediation Model of HIV Knowledge, Gender and HIV Test Uptake

Introduction: Sub-Saharan Africa has been particularly impacted by the HIV epidemic with an estimated 24.7 million out of 36.9 million people living with HIV/AIDS (PLWH). Nigeria has the second highest number of people living with HIV/AIDS in the world. Despite various prevention efforts, HIV related knowledge and HIV testing remain low while stigmatizing attitudes for PLWH are still high. Previous research has shown that people who know someone with HIV tend to have lower stigmatizing attitudes; however the role that HIV related knowledge plays in this relationship has not been examined. Aim: The purpose of this study is to examine the relationship between knowledge of someone infected by HIV/AIDS (KSIH) and HIV stigma, and whether HIV related knowledge mediates this relationship. We further examined the moderating role of gender and HIV test uptake. Methodology: The current study utilized data from the 2013 Nigeria Demographic Health Survey, a nationally representative cross-sectional survey designed to obtain data on key health related indicators. Descriptive statistics and vicariate correlations were first conducted. Structural equation modeling was then used to conduct mediation and moderated mediation analyses. Results: Results showed that HIV related knowledge mediated the relationship between knowledge of someone infected with HIV and HIV stigma. Moderated mediation results revealed that gender the indirect effect of HIV knowledge of the relationship between KSIH and HIV stigma, with the conditional effect being stronger for women. Additionally, HIV test uptake moderated the relationship between KSIH and HIV stigma, with the effect being stronger among those previously tested for HIV. Conclusion: This is the first study to show the mediating role of HIV related knowledge in the relationship between KSIH and HIV stigma in addition to the effect of various social demographic factors. Further, the study highlights clinical and outreach implications of including anti-stigma messages as part of HIV testing counseling and campaigns.