Key Social Norms Take-aways This study highlights how community-level HIV stigma—specifically stigmatizing attitudes and disclosure concerns—can shape normative beliefs that influence HIV transmission risk behaviors. Stigmatizing norms contribute to low condom usage and increased rates of self-reported sexually transmitted diseases (STDs), especially among women. These norms reflect broader societal fears and discriminatory attitudes that marginalize people living with HIV and discourage open communication about HIV status and prevention.

Objectives The study aimed to assess whether individual- and community-level HIV stigma—measured as stigmatizing attitudes and HIV disclosure concerns—were associated with HIV transmission risk behaviors (condom use) and self-reported STDs in Sierra Leone. It also investigated whether gender modified these associations.

Methods Researchers pooled data from the 2008 and 2013 Sierra Leone Demographic and Health Surveys (DHS), including 24,030 sexually active respondents who had heard of HIV. HIV stigma was measured using indicators of stigmatizing attitudes (e.g., willingness to interact with people living with HIV) and disclosure concerns (desire to keep a family member’s HIV status secret). Both individual- and community-level stigma were analyzed using multivariable logistic regression models adjusted for demographic and socio-economic variables. Gender-stratified analyses tested for effect modification.

Intervention Details Not applicable – this was a population-based observational study, not an intervention.

Results Community-level stigmatizing attitudes were associated with significantly higher odds of self-reported STDs (AOR=2.07), while community-level disclosure concerns were also strongly associated with increased STD risk (AOR=2.95). Individual-level stigma was linked to lower odds of recent and consistent condom use. Gender modified many of these associations: among women, community-level stigma and disclosure concerns were more strongly associated with risky sexual behavior and higher STD rates. In contrast, among men, community-level disclosure concerns were weakly associated with safer behaviors. Condom usage was generally low (6% reported use at last sex), and over half of respondents expressed HIV disclosure concerns.

Conclusions Community-level HIV stigma, particularly around disclosure and attitudes toward people living with HIV, significantly contributes to sexual risk and STD vulnerability in Sierra Leone. Women are especially affected by these norms. Addressing HIV stigma at both individual and community levels—through gender-sensitive, stigma-reduction strategies—is essential to reduce HIV transmission risks and improve public health outcomes.