Table 2 Coding tree for identifying several mechanisms and pathways for stigma reduction and HIV test uptake

Contextual factors

Structural factors

Homosexuality legislation, voluntary or mandatory reporting policies

Health system factors

Health care quality and access, higher staff morale, effective referral, confidentiality, ongoing national health programs, discrimination at health care, increased partnership with community organizations

Community factors

Social support, traditional beliefs and practices, gender norms, peer pressure, family testing, PLWH in the neighbourhood, gender-based violence, resource constraints, communication gap in the family (sexual taboo),

Individual factors

Previous history of testing, gender, age, education, income, distance to health centre, urban-rural residence, increased risk-perception, self-confidence, higher self-esteem, intentions to test, trust in health care

Stigma Reduction Intervention Strategies

Awareness

Radio TV messages, mass media and interpersonal communication, film, health education program, role plays, group discussions, HIV advocate testimony, presentation, workshop, questions and answers, mobile phone messaging, training, motivational interviews, peer education

Public health services

ART, opt-out testing, prevention from mother to child transmission, VCT, mobile VCT, home based VCT, Integrating HIV and RH services, community testing, family based testing and counselling, involvement of PLWH in the intervention

Community mobilization

Child clubs, mobilization of community local counsellors, discussion with community leaders, mobilization of traditional health practitioners

Support

Socio-economic support for community participation, contact with affected group, improving coping skills through involvement and empowerment, post-test support services, incentives

Regulatory laws

Formation of hospital steering committee to oversee quality of care, hospital (confidentiality) policy development, material supply for practicing universal precautions, providing incentives for testing

Mechanisms of stigma reduction

Increase knowledge

Knowledge about HIV is manageable, prevention measures, changed negative beliefs, changed community norms, normalization, knowledge about universal precautions, changed sexual taboo

Change attitude

Reduced fear (self-stigma), reduced perceived stigma (shame and worrisome), acceptance of testing services, increased tolerance and comfort with PLWH in variety of situations, acceptance of PLWH; respect for confidentially among health workers, less endorsement of policies to separate PLWH

Change behaviour

Comfort, interaction of PLWH in the community, lower tendencies to exclude PLWH, less blame, reduced enacted stigma experiences, involving PLWH in the community, encouraging others to test

Outcome

Proximal outcomes

Improved knowledge, reduced fear, reduced shame, reduced blame, reduced discrimination and increased interaction

Distal outcomes

HIV test uptake, self-efficacy and intentions to test for HIV