Key Social Norms Take-aways Discriminatory attitudes toward people living with HIV remain widespread in East Africa and appear to be shaped by broader socioeconomic and social contexts. Nearly half of the variation in discriminatory attitudes occurred between communities, underscoring that stigma is not solely an individual attitude but is embedded within social environments. The discussion suggests that economic disadvantage, limited access to information and social networks, moralized perceptions of sexual behavior, cultural norms, and misinformation can reinforce stigmatizing attitudes. Stigma-reduction efforts should therefore address structural and socioeconomic conditions alongside HIV knowledge and beliefs about transmission and sexual behavior.

Objectives To estimate the prevalence of discriminatory attitudes toward people living with HIV and identify associated individual- and community-level factors across five East African countries using nationally representative data collected from 2019–2023.

Methods This cross-sectional secondary analysis used Demographic and Health Survey data from Kenya, Madagascar, Mozambique, Rwanda, and Tanzania, including a weighted sample of 106,639 sexually active women and men ages 15–49. Multilevel logistic regression examined individual- and community-level correlates of discriminatory attitudes. Discriminatory attitudes were measured using two social-distance and exclusion items: whether children living with HIV should be allowed to attend school with children without HIV and whether respondents would purchase vegetables from a vendor living with HIV. A “no” response to either was classified as discriminatory. The authors emphasize that these measures are proxies for discriminatory attitudes rather than comprehensive measures of internalized, enacted, or structural stigma.

Results Overall, 34.03% of respondents reported discriminatory attitudes, ranging from 12.98% in Rwanda to 76.18% in Madagascar. Lower wealth was associated with approximately twice the odds of discriminatory attitudes (adjusted odds ratio=2.12), as was having multiple sexual partners (adjusted odds ratio=2.11); unemployment was associated with approximately three times the odds (adjusted odds ratio=3.10). Substantial clustering was observed across communities, indicating meaningful contextual variation in discriminatory attitudes.

Conclusions Discriminatory attitudes toward people living with HIV remain common across East Africa and are associated with socioeconomic disadvantage and behavioral factors. The authors recommend combining economic empowerment and employment initiatives with targeted awareness campaigns, comprehensive sexuality education, HIV information, and health-system stigma-reduction efforts to foster more inclusive attitudes and improve outcomes for people living with HIV.