Discriminatory attitudes toward people living with HIV/AIDS in East Africa: a multilevel analysis of socioeconomic and behavioral determinants using DHS 2019–2023 data

Abstract

INTRODUCTION: Despite global efforts to reduce HIV-related stigma, discriminatory attitudes toward people living with HIV/AIDS (PLHIV) remain widespread, especially in Sub-Saharan Africa. This study aimed to assess the prevalence and determinants of discriminatory attitudes toward PLHIV in five East African countries using Demographic and Health Survey (DHS) data from 2019 to 2023. METHODS: A cross-sectional, secondary data analysis was conducted using DHS data from Kenya, Madagascar, Mozambique, Rwanda, and Tanzania. A total weighted sample of 106,639 sexually active individuals aged 15-49 was included. Discriminatory attitudes were assessed based on responses to two standard DHS questions. Multilevel logistic regression models were used to identify factors associated with discriminatory attitudes at both individual and community levels. RESULTS: The overall prevalence of discriminatory attitudes toward PLHIV was 34.03% (95% CI 33.74, 34.31). Country-specific prevalence ranged from 12.98% in Rwanda to 76.18% in Madagascar. Key factors significantly associated with discriminatory attitudes included lower wealth status (AOR = 2.12, CI 1.73, 3.80), having multiple sexual partners (AOR = 2.11, CI 1.97, 2.60), and being unemployed (AOR = 3.10, CI 2.06, 3.70). CONCLUSION: Discriminatory attitudes toward PLHIV remain high in East Africa, particularly among economically disadvantaged, unemployed individuals and have multiple sexual partners. Integrated interventions targeting socio-economic inequalities, sexual health education, and employment opportunities help reduce discriminatory attitudes toward PLHIV.