{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T17:36:53Z","timestamp":1792690613267,"version":"4.5.0"},"reference-count":34,"publisher":"BMJ","issue":"10","funder":[{"DOI":"10.13039\/100000200","name":"United States Agency for International Development","doi-asserted-by":"publisher","award":["Cooperative Agreement #AID-OAA-A-12-00058"],"award-info":[{"award-number":["Cooperative Agreement #AID-OAA-A-12-00058"]}],"id":[{"id":"10.13039\/100000200","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,9,4]]},"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Increasing and sustaining engagement in HIV care for people living with HIV are critical to both individual therapeutic benefit and epidemic control. Men are less likely to test for HIV compared with women in sub-Saharan African countries, and ultimately have delayed entry to HIV care. Stigma is known to impede such engagement, placing an importance on understanding and addressing stigma to improve HIV testing and care outcomes. This study aimed to assess the gendered differences in the relationship between stigma and HIV testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design and setting<\/jats:title>\n                    <jats:p>A cross-sectional, household probability survey was implemented between November and December 2016 in the Sofala province of Mozambique.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Data were restricted to men and women participants who reported no prior diagnosis of HIV infection (N=2731).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measures<\/jats:title>\n                    <jats:p>Measures of sociodemographic characteristics, stigma and past exposure to HIV interventions were included in gender-stratified logistic regression models to estimate the relationship between stigma and recent testing for HIV, as well as to identify other relevant correlates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significantly fewer men (38.3%) than women (47.6%; p&lt;0.001) had recently tested for HIV. Men who reported previous engagement in community group discussions about HIV had an increased odds of testing in the past 12 months compared to those who had not participated (adjusted OR (aOR)=1.92; 95% CI 1.51 to 2.44). Concerns about stigma were not a commonly reported barrier to HIV testing; however, men who expressed anticipated individual HIV stigma had a 35% lower odds of recent HIV testing (aOR=0.65; 95% CI 0.44 to 0.96). This association was not observed among women.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Men have lower uptake of HIV testing in Mozambique when compared to women. Even amidst the beneficial effects of HIV messaging, individual stigma is negatively associated with recent HIV testing among men. Intervention efforts that target the unique challenges and needs of men are essential in promoting men\u2019s engagement into the HIV care continuum in sub-Saharan Africa.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-029748","type":"journal-article","created":{"date-parts":[[2019,10,8]],"date-time":"2019-10-08T07:24:19Z","timestamp":1570519459000},"page":"e029748","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":42,"title":["Gendered relationship between HIV stigma and HIV testing among men and women in Mozambique: a cross-sectional study to inform a stigma reduction and male-targeted HIV testing intervention"],"prefix":"10.1136","volume":"9","author":[{"given":"Judy H","family":"Ha","sequence":"first","affiliation":[{"name":"Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lynn M","family":"Van Lith","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C","family":"Mallalieu","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Chidassicua","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Dirce","family":"Pinho","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Devos","sequence":"additional","affiliation":[{"name":"Johns Hopkins University Center for Communication Programs, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea L","family":"Wirtz","sequence":"additional","affiliation":[{"name":"Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,10,7]]},"reference":[{"key":"2025121605361900000_9.10.e029748.1","unstructured":"UNAIDS . 90\u201390\u201390 - An ambitious treatment target to help end the AIDS epidemic, 2014. Available: http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/90-90-90_en.pdf [Accessed 21 Apr 2018]."},{"key":"2025121605361900000_9.10.e029748.2","unstructured":"UNAIDS . Miles to go: closing gaps, breaking barriers, righting injustices, 2018. Available: http:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/miles-to-go_en.pdf [Accessed 10 Jan 2019]."},{"key":"2025121605361900000_9.10.e029748.3","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2009.159723"},{"key":"2025121605361900000_9.10.e029748.4","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.19.1.20605","article-title":"Antenatal care and uptake of HIV testing among pregnant women in sub-Saharan Africa: a cross-sectional study","volume":"19","author":"Gunn","year":"2016","journal-title":"J Int AIDS Soc"},{"key":"2025121605361900000_9.10.e029748.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pmed.1001167","article-title":"Engaging men in prevention and care for HIV\/AIDS in Africa","volume":"9","author":"Mills","year":"2012","journal-title":"PLoS Med"},{"key":"2025121605361900000_9.10.e029748.6","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.19.1.21106","article-title":"Marked sex differences in all-cause mortality on antiretroviral therapy in low- and middle-income countries: a systematic review and meta-analysis","volume":"19","author":"Beckham","year":"2016","journal-title":"J Int AIDS Soc"},{"key":"2025121605361900000_9.10.e029748.7","doi-asserted-by":"publisher","DOI":"10.1177\/00027649921954822"},{"issue":"3 Suppl 2","key":"2025121605361900000_9.10.e029748.8","doi-asserted-by":"crossref","DOI":"10.7448\/IAS.16.3.18640","article-title":"Impact of HIV-related stigma on treatment adherence: systematic review and meta-synthesis","volume":"16","author":"Katz","year":"2013","journal-title":"J Int AIDS Soc"},{"key":"2025121605361900000_9.10.e029748.9","first-page":"49","article-title":"Fear of stigmatization as barrier to voluntary HIV counselling and testing in South Africa","volume":"5","author":"Meiberg","year":"2008","journal-title":"East Afri J Public Health"},{"key":"2025121605361900000_9.10.e029748.10","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.92.3.378"},{"key":"2025121605361900000_9.10.e029748.11","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0173928","article-title":"Significant association between perceived HIV related stigma and late presentation for HIV\/AIDS care in low and middle-income countries: a systematic review and meta-analysis","volume":"12","author":"Gesesew","year":"2017","journal-title":"PLoS One"},{"key":"2025121605361900000_9.10.e029748.12","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2016-011453","article-title":"Examining the associations between HIV-related stigma and health outcomes in people living with HIV\/AIDS: a series of meta-analyses","volume":"6","author":"Rueda","year":"2016","journal-title":"BMJ Open"},{"key":"2025121605361900000_9.10.e029748.13","doi-asserted-by":"crossref","DOI":"10.1186\/1471-2458-13-220","article-title":"A systematic review of qualitative findings on factors enabling and deterring uptake of HIV testing in sub-Saharan Africa","volume":"13","author":"Musheke","year":"2013","journal-title":"BMC Public Health"},{"key":"2025121605361900000_9.10.e029748.14","unstructured":"UNAIDS . Country factsheets: Mozambique 2016, 2017. Available: http:\/\/www.unaids.org\/en\/regionscountries\/countries\/mozambique [Accessed 16 Mar 2018]."},{"key":"2025121605361900000_9.10.e029748.15","unstructured":"The Demographic and Health Surveys (DHS) Program . DHS survey: 2018. Mozambique: standard AIS, 2015. Available: https:\/\/dhsprogram.com\/what-we-do\/survey\/survey-display-467.cfm [Accessed 16 Mar 2018]."},{"key":"2025121605361900000_9.10.e029748.16","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0106760","article-title":"Awareness of HIV status, prevention knowledge and condom use among people living with HIV in Mozambique","volume":"9","author":"Dokubo","year":"2014","journal-title":"PLoS One"},{"key":"2025121605361900000_9.10.e029748.17","doi-asserted-by":"crossref","DOI":"10.1093\/ofid\/ofx156","article-title":"Advanced human immunodeficiency virus disease at diagnosis in Mozambique and Swaziland","volume":"4","author":"Kujawski","year":"2017","journal-title":"Open Forum Infect Dis"},{"key":"2025121605361900000_9.10.e029748.18","doi-asserted-by":"publisher","DOI":"10.1089\/aid.2014.0007"},{"key":"2025121605361900000_9.10.e029748.19","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1016\/j.healthplace.2014.04.007","article-title":"Spatial and social inequities in HIV testing utilization in the context of rapid scale-up of HIV\/AIDS services in rural Mozambique","volume":"28","author":"Yao","year":"2014","journal-title":"Health Place"},{"key":"2025121605361900000_9.10.e029748.20","unstructured":"Global Network of People Living with HIV, International Planned Parenthood Federation, International Community of Women Living with HIV\/AIDS, UNAIDS . The people living with HIV stigma index, Geneva 2008. Available: http:\/\/www.stigmaindex.org\/ [Accessed 1 Jul 2018]."},{"key":"2025121605361900000_9.10.e029748.21","doi-asserted-by":"crossref","first-page":"11","DOI":"10.2989\/16085906.2016.1264983","article-title":"The multidimensional nature of HIV stigma: evidence from Mozambique","volume":"16","author":"Carrasco","year":"2017","journal-title":"Afr J AIDS Res"},{"key":"2025121605361900000_9.10.e029748.22","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-007-9340-6"},{"key":"2025121605361900000_9.10.e029748.23","unstructured":"The Demographic and Health Surveys (DHS) Program . Aids indicator survey (AIS), 201. Available: https:\/\/dhsprogram.com\/What-We-Do\/Survey-Types\/AIS.cfm [Accessed 16 Mar 2018]."},{"key":"2025121605361900000_9.10.e029748.24","unstructured":"StataCorp . Stata statistical software: release 14. College Station, TX StataCorp; 2015."},{"key":"2025121605361900000_9.10.e029748.25","doi-asserted-by":"publisher","DOI":"10.1521\/aeap.2015.1.58"},{"issue":"Suppl 2","key":"2025121605361900000_9.10.e029748.26","doi-asserted-by":"crossref","DOI":"10.1186\/1472-6963-13-S2-S4","article-title":"Strengthening integrated primary health care in Sofala, Mozambique","volume":"13","author":"Sherr","year":"2013","journal-title":"BMC Health Serv Res"},{"key":"2025121605361900000_9.10.e029748.27","doi-asserted-by":"publisher","DOI":"10.1177\/1049732315580302"},{"key":"2025121605361900000_9.10.e029748.28","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-016-1341-x"},{"key":"2025121605361900000_9.10.e029748.29","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0195391","article-title":"Acceptability and performance of a directly assisted oral HIV self-testing intervention in adolescents in rural Mozambique","volume":"13","author":"Hector","year":"2018","journal-title":"PLoS One"},{"key":"2025121605361900000_9.10.e029748.30","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1080\/10810730.2015.1114050","article-title":"Effectiveness of community dialogue in changing gender and sexual norms for HIV prevention: evaluation of the Tchova Tchova program in Mozambique","volume":"21","author":"Figueroa","year":"2016","journal-title":"J Health Commun"},{"key":"2025121605361900000_9.10.e029748.31","unstructured":"Myers M . Radio and development in Africa: a concept paper. International development research centre (IDRC), 2008. Available: http:\/\/www.amarc.org\/documents\/manuals\/12481943581Radio_and_Development_in_Africa,_a_concept_paper.pdf [Accessed 1 Jul 2018]."},{"key":"2025121605361900000_9.10.e029748.32","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2012.689810"},{"key":"2025121605361900000_9.10.e029748.33","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.301069"},{"key":"2025121605361900000_9.10.e029748.34","doi-asserted-by":"publisher","DOI":"10.1097\/01aids.0000341777.78876.40"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2019-029748","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,16]],"date-time":"2025-12-16T13:36:34Z","timestamp":1765892194000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2019-029748"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10]]},"references-count":34,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,10,7]]},"published-print":{"date-parts":[[2019,10]]}},"alternative-id":["10.1136\/bmjopen-2019-029748"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2019-029748","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,10]]}}}