Table 1 shows the association between the percentage of HIV-positive patients who felt ashamed or not ashamed because of their HIV status by selected background characteristics. Feeling ashamed among HIV-positive patients varied based on age, place of residence, health status, and negative social interactions. Younger HIV patients aged 15-19 years were less likely to feel ashamed (21%), with 78.7% disagreeing with feeling ashamed, whereas those in the 45-49 years age group showed higher levels of shame, with only 53.8% disagreeing. Compared with urban residents, rural residents were more likely to feel ashamed, with 38.6% in rural areas agreeing with feeling ashamed versus 36% in urban areas.
Patients reporting excellent health were more likely to feel ashamed (47.2% agree) than those reporting moderate health (29.7% agree). A total of 52.3% of the patients with poor health status agreed that they felt ashamed. Experiences related to HIV status also played a significant role: patients who did not face negative talk from others showed greater disagreement with feeling ashamed (69.5%), while those who faced negative talk had greater agreement (52%). Similarly, patients who did not experience verbal insults or harassment disagreed more with feeling ashamed (66.7%) than did those who did (46.6%).
Table 1: Descriptive results of HIV+ women who felt ashamed and not ashamed because of their HIV status according to selected background characteristics
Variables
|
disagree
|
agree
|
N =332
|
|
%
|
n
|
%
|
n
|
|
age in 5 year groups
|
|
|
|
|
|
15-19
|
78.7
|
7
|
21.3
|
2
|
9
|
20-24
|
50.8
|
10
|
49.2
|
9
|
19
|
25-29
|
60.9
|
15
|
39.1
|
9
|
24
|
30-34
|
65.2
|
32
|
34.8
|
17
|
48
|
35-39
|
66.9
|
55
|
33.1
|
27
|
82
|
40-44
|
64.5
|
51
|
35.5
|
28
|
78
|
45-49
|
53.8
|
38
|
46.2
|
33
|
71
|
type of place of residence
|
|
|
|
|
|
urban
|
64
|
69
|
36
|
39
|
108
|
rural
|
61.4
|
137
|
38.6
|
86
|
224
|
self-reported health status
|
|
|
|
|
|
very good
|
52.8
|
17
|
47.2
|
15
|
32
|
good
|
62.2
|
82
|
37.8
|
50
|
132
|
moderate
|
70.3
|
85
|
29.7
|
36
|
122
|
bad
|
47.7
|
22
|
52.3
|
24
|
46
|
things happened because HIV positive status: people talk badly
|
|
|
|
|
|
no
|
69.5
|
153
|
30.5
|
67
|
220
|
yes
|
48
|
54
|
52
|
58
|
112
|
things happened because HIV positive status: someone else disclosed the status
|
|
|
|
|
|
no
|
68.5
|
161
|
31.5
|
74
|
235
|
yes
|
47.2
|
46
|
52.8
|
51
|
97
|
things happened because HIV positive status: verbally insulted/harassed/threaten
|
|
|
|
|
|
no
|
66.7
|
172
|
33.3
|
86
|
258
|
yes
|
46.6
|
34
|
53.4
|
39
|
74
|
things happened because HIV positive status: healthcare workers talked badly
|
|
|
|
|
|
no
|
62.7
|
187
|
37.3
|
111
|
298
|
yes
|
58.6
|
20
|
41.4
|
14
|
34
|
things happened because HIV positive status: healthcare workers verbally abused
|
|
|
|
|
|
no
|
63.2
|
200
|
36.8
|
117
|
317
|
yes
|
43.6
|
7
|
56.4
|
9
|
15
|
Table 2 shows the odds ratios and P values from the bivariate analysis, with factors individually associated with shame highlighted. Significant factors associated with shame included negative social interactions, such as people talking badly due to HIV status, disclosure of HIV status by others, and verbal harassment or abuse. Patients who experienced negative talk due to their HIV status had significantly greater odds of feeling ashamed (OR=2.29, 95% CI: 1.43-3.66, P=0.00). Similarly, those whose HIV status was disclosed by someone else were significantly more likely to feel ashamed (OR=2.52, 95% CI: 1.54-4.12; P=0.00).
Verbal insults or harassment were also significantly associated with increased odds of feeling ashamed (OR=2.20, 95% CI: 1.29-3.77; P=0.004). Additionally, negative behaviour by healthcare workers was a strong factor, with patients experiencing negative talk from healthcare workers showing significantly greater odds of shame (OR=2.81, 95% CI: 1.24-6.34, P=0.013) and those verbally abused by healthcare workers having even greater odds of feeling ashamed (OR=6.57, 95% CI: 1.82-23.74, P=0.004).
Table 2: Bivariate association of shame among HIV+ patients by selected background characteristics
Variables
|
UOR (95% CI)
|
P value
|
|
|
|
age in 5 year groups
|
|
|
15-19
|
1.00 (1.00, 1.00)
|
|
20-24
|
3.37 (0.68, 17.00)
|
0.14
|
25-29
|
2.49 (0.53, 11.81)
|
0.25
|
30-34
|
1.58 (0.38, 6.61)
|
0.53
|
35-39
|
1.67 (0.42, 6.63)
|
0.47
|
40-44
|
2.16 (0.54, 8.65)
|
0.28
|
45-49
|
2.32 (0.58, 9.31)
|
0.23
|
type of place of residence
|
|
|
urban
|
1.00 (1.00, 1.00)
|
|
rural
|
0.95 (0.62, 1.56)
|
0.95
|
self reported health status
|
|
|
very good
|
1.00 (1.00, 1.00)
|
|
good
|
0.82 (0.38, 1.75)
|
0.61
|
moderate
|
0.60 (0.27, 1.31)
|
0.20
|
bad
|
1.98 (0.79, 4.98)
|
0.15
|
very bad
|
1
|
|
things happened because hiv positive status: people talk badly
|
|
|
no
|
1.00 (1.00,1.00)
|
|
yes
|
2.29 (1.43, 3.66)
|
0.00***
|
things happened because HIV positive status: someone else disclosed the status
|
|
|
no
|
1.00 (1.00, 1.00)
|
|
yes
|
2.52 (1.54, 4.12)
|
0.00***
|
things happened because HIV positive status: verbally insulted/harassed/threaten
|
|
|
no
|
1.00 (1.00, 1.00)
|
|
yes
|
2.20 (1.29, 3.77)
|
0.004***
|
things happened because HIV positive status: healthcare workers talked badly
|
|
|
no
|
1.00 (1.00, 1.00)
|
|
yes
|
2.81 (1.24, 6.34)
|
0.013**
|
things happened because HIV positive status: healthcare workers verbally abused
|
|
|
no
|
1.00 (1.00, 1.00)
|
|
yes
|
6.57 (1.82, 23.74)
|
0.004***
|
|
|
|
|
Note: ***p < 0.01, ** p < 0.05, UOR: Unadjusted odds ratio
Table 3 presents the results from a multiple logistic regression model to establish factors associated with shame among HIV-positive women. The only factor found to be significantly related to feelings of shame was the disclosure of HIV status by someone else. Women whose HIV status was disclosed by someone else had significantly greater odds of feeling ashamed than did their counterparts whose status was not disclosed by others. (AOR=1.98, 95% CI: 1.08-3.65, P=0.028).
Although not statistically significant, other factors were associated with increased odds of experiencing shame. For example, women aged 20-24 years had greater odds (AOR=3.65, 95% CI: 0.66-20.14, P=0.24), and those who experienced verbal abuse from healthcare workers also had greater odds (AOR=3.73, 95% CI: 0.84-16.56, P=0.08).
Table 3: Logistic Regression Analysis of Factors Associated with Agreement to Shame among Self-Reported HIV-Diagnosed Patients in Kenya
Characteristics
|
AOR (95% CI)
|
P- Value
|
Age in 5-year groups
|
15-19
|
1
|
|
20-24
|
3.65 (0.66,20.32)
|
0.14
|
25-29
|
2.79 (0.54, 14.51)
|
0.22
|
30-34
|
1.75 (0.39, 7.95)
|
0.47
|
35-39
|
1.89 (0.44, 8.10)
|
0.39
|
40-44
|
2.23 (0.52, 9.48)
|
0.28
|
45-49
|
2.41 (0.56, 10.33)
|
0.24
|
type of place of residence
|
|
|
urban
|
1
|
|
rural
|
0.99 (0.60, 1.63)
|
0.96
|
self-reported health status
|
|
|
very good
|
1
|
|
good
|
0.84 (0.38, 1.87)
|
0.68
|
moderate
|
0.56 (0.24, 1.27)
|
0.16
|
bad
|
1.73 (0.67, 4.48)
|
0.26
|
things happened because HIV positive status: someone else disclosed the status
|
|
|
no
|
1
|
|
yes
|
1.98 (1.08, 3.65)
|
0.028**
|
things happened because HIV positive status: verbally insulted/harassed/threaten
|
|
|
no
|
1
|
|
yes
|
1.30 (0.65, 2.62)
|
0.46
|
things happened because HIV positive status: healthcare workers talked badly
|
|
|
no
|
1
|
|
yes
|
1.09 (0.39, 3.05)
|
0.87
|
things happened because HIV positive status: healthcare workers verbally abused
|
|
|
no
|
1
|
|
yes
|
3.73 (0.84, 16.56)
|
0.08
|
Note: ***p < 0.01, ** p < 0.05, AOR: adjusted odds ratio