Impact of Universal Test and Treat (UTT) on anticipated stigma among patients newly diagnosed with HIV in Johannesburg, South Africa: A cross-sectional study

Anticipated stigma-the fear that an HIV diagnosis and disclosure may lead to negative social consequences that undermine engagement in HIV care, even in the era of universal test-and-treat (UTT). This study aimed to estimate the prevalence of anticipated stigma and identify its predictors among newly HIV-diagnosed adults in Johannesburg, South Africa, where treatment is available. We conducted a cross-sectional survey among 652 adults (≥18 years) newly diagnosed with HIV between October 2017 and August 2018 at four primary healthcare clinics in Johannesburg. Participants (64.1% female; median age 33 years, IQR 28-39) were interviewed immediately after receiving their HIV test results. Anticipated stigma was measured using an adapted five-item, four-point scale assessing concerns related to HIV disclosure and concealment (Cronbach's alpha = 0.82). Mean scores were categorized as low-to-medium (≤2.5) or high (>2.5). Modified Poisson regression was used to identify predictors of high anticipated stigma, reported as adjusted risk ratios (aRRs) with 95% confidence intervals (CIs). Overall, 55% of participants reported high anticipated stigma. Prevalence was higher among males (55.8%) and young adults aged 18-29 years (61.1%), and lower among married individuals (43%). Compared to married participants, those in unmarried relationships were more likely to report high anticipated stigma (aRR 1.10, 95% CI: 1.01-1.18). Lower anticipated stigma was observed among older individuals (aRR 0.94 for ages 30-39 vs 18-29), those whose primary home was in another province or country, those living in their current home for five or more years, individuals with fewer ART-related concerns, and those reporting lower perceived social support. Despite universal access to HIV treatment, over half of newly diagnosed adults reported high anticipated stigma. These findings underscore the need for targeted interventions to address persistent drivers of stigma, strengthen coping skills, and support social integration to promote engagement in HIV care.