Original Research

Geographic differences in the experiences of HIV-related stigma for women living with HIV in northern and rural communities of Ontario, Canada


Denise Jaworsky1 MD, Clinical Instructor *

Carmen H Logie2 PhD, Assistant Professor

Anne C Wagner3 PhD, Postdoctoral Fellow

Tracey Conway4 Child and Youth Worker Diploma, Research Associate

Angela Kaida5 PhD, Associate Professor and Canada Research Chair in Global Perspectives in HIV and Sexual and Reproductive Health

Alexandra de Pokomandy6 MD, Assistant Professor

Kath Webster7 N/A, Research Associate

Karène Proulx-Boucher8 MA, Research Coordinator

Paul Sereda9 BA, Lead Data Analyst

Mona Loutfy10 MD, Professor

CHIWOS (Canadian HIV Women’s Sexual & Reproductive Health Cohort Study) Research Team11


1 Department of Medicine, University of British Columbia, 2775 Laurel Street, 10th Floor, Vancouver, BC Canada, V5Z 1M9 and Institute for Health Policy, Management & Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, Canada, M5T 3M6

2 Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St. West, Toronto, ON, Canada, M5S 1V4

3 Ryerson University, 350 Victoria Street, Toronto, ON, Canada, M5B 2K3

4, 7, 11 CHIWOS (Canadian HIV Women’s Sexual & Reproductive Health Cohort Study), 76 Grenville St, 6th Floor, Toronto, ON, Canada, M5S 1B3

5 Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Rm 10522, 8888 University Drive, Burnaby, BC, Canada V5A 1S6

6, 8 Chronic Viral Illness Service, McGill University health Centre, 1001 Decarie Blvd, Montreal, QC, Canada, H4A 3J1

9 British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard St, Vancouver, BC, Canada, V6Z 1Y6

10 Institute for Health Policy, Management & Evaluation, University of Toronto, 155 College Street, Suite 425, Toronto, ON, Canada, M5T 3M6 and Women's College Research Institute, 76 Grenville St, 6th Floor, Toronto, ON, Canada, M5S 1B3

ACCEPTED: 13 November 2017

early abstract:

Introduction: In Canada, individuals living in Northern and rural regions report more barriers to health service access. For people living with HIV, these barriers may be exacerbated by experiences of HIV-related stigma and women living with HIV can be disproportionately impacted due to intersections of multiple forms of oppression including racism, sexism and classism. To further understand the impact of geography on the wellbeing of women living with HIV, this study assessed geographic differences in HIV-related stigma experiences among women in the Canadian HIV Women’s Sexual & Reproductive Health Cohort Study (CHIWOS).

Methods: CHIWOS is a multisite cohort study of women living with HIV in Canada that operates under community-based participatory research methodology along with GIPA (greater involvement of people with HIV/AIDS) and MIWA (meaningful involvement of women living with HIV/AIDS) principles.  This analysis compared Peer Research Associate-administered questionnaire data between participants in Northern and Southern Ontario, Canada and also between participants in rural and non-rural Ontario. Northern regions were defined by healthcare delivery jurisdiction. The primary outcome was the 10-item shortened HIV Stigma Scale score. Multivariable linear regression models assessed the association between rural and Northern regions and stigma score.

Results: Sixteen women were excluded due to incomplete HIV Stigma Scale data. Of 701 women included in the analysis, 66 (9.4%) were from Northern regions and 24 (3.4%) were from rural regions. Mean stigma scores were 23.9 (SD 8.0) overall, 26.7 (SD 8.8) in Northern regions, 23.6 (SD 7.9) in Southern regions, 28.3 (SD 10.1) in rural regions, and 23.8 (SD 7.8) in non-rural regions. In multivariable analyses, Northern and rural regions of residence were associated with a 3.05 (95% CI: 0.77, 5.32) and 4.83 (95% CI: 1.37, 8.28) point increase in stigma score, respectively.

Conclusion: Living in both Northern and rural regions of Ontario was associated with higher HIV Stigma Scale scores. These geographic discrepancies in experiences of HIV-related stigma highlight the need for region-specific programs to reduce HIV-related stigma and to support people living with HIV who are impacted by HIV-related stigma, particularly those living in geographically isolated regions. Prior qualitative studies have documented the important impact of HIV-related stigma, and this study supports these observations with quantitative data from a population that is often under-represented in HIV research.