Human Nature

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Reframing HIV Stigma and Fear

Considerations from Social-ecological and Evolutionary Theories of Reproduction
  • Caitlyn D. Placek
  • Holly Nishimura
  • Natalie Hudanick
  • Dionne Stephens
  • Purnima MadhivananEmail author


HIV stigma and fears surrounding the disease pose a challenge for public health interventions, particularly those that target pregnant women. In order to reduce stigma and improve the lives of vulnerable populations, researchers have recognized a need to integrate different types of support at various levels. To better inform HIV interventions, the current study draws on social-ecological and evolutionary theories of reproduction to predict stigma and fear of contracting HIV among pregnant women in South India. The aims of this study were twofold: compare the social-ecological model to a modified maternal-fetal protection model and test a combined model that included strong predictors from each model. The study took place in 2008–2011 in Mysore District, Karnataka, India. Using data from a cross-sectional survey and biological indicators of health, we statistically modeled social-ecological variables representing individual, interpersonal, and community/institutional levels. Participants were 645 pregnant women. The social-ecological and combined models were the best-fitting models for HIV-related stigma, and the combined model was the best fit for HIV-related fear. Our findings suggest that combining reproductive life history factors along with individual, interpersonal, and community/institutional factors are significant indicators of HIV-related stigma and fear. Results of this study support a multifaceted approach to intervention development for HIV-related stigma and fear. The combined model in this study can be used as a predictive model for future research focused on HIV stigma and fear, with the intent that dual consideration of social-ecological and evolutionary theories will improve public health communication efforts.


Social-ecological model Maternal-fetal protection HIV/AIDS stigma Pregnancy India Evolutionary medicine 



The authors would like to thank study participants, research assistants, and PHRII staff for their assistance in the study design and data collection process. Thank you to James Jones, Edward Hagen, and Marsha Quinlan for comments and suggestions on earlier iterations of this manuscript. The Kisalaya mobile clinic project was funded by the Elizabeth Glaser Pediatric AIDS Foundation International Leadership Award to Purnima Madhivanan. Caitlyn Placek was supported by the Global Health Equity Scholars Training Grant from Fogarty International Center at National Institutes of Health (R25 TW009338). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  • Caitlyn D. Placek
    • 1
    • 2
    • 3
  • Holly Nishimura
    • 4
  • Natalie Hudanick
    • 1
  • Dionne Stephens
    • 5
  • Purnima Madhivanan
    • 2
    • 3
    Email author
  1. 1.Department of AnthropologyBall State UniversityMuncieUSA
  2. 2.Department of EpidemiologyRobert Stempel College of Public Health and Social Work, Florida International UniversityMiamiUSA
  3. 3.Public Health Research Institute of IndiaMysoreIndia
  4. 4.School of Public HealthUniversity of California at BerkeleyBerkeleyUSA
  5. 5.Department of PsychologyFlorida International UniversityMiamiUSA

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