Declining but increasingly concentrated HIV stigma in rural Uganda: population-based cohort study, 2014-2024

BackgroundHIV-related stigma remains a primary barrier to the elimination of the HIV epidemic worldwide. No studies have examined long-term changes in the distribution of stigmatizing attitudes within populations. MethodsWe conducted a whole-population, open cohort study of adults in 8 villages in rural southwestern Uganda, with 5 biennial surveys spanning 2014-2024 (N=1,776 at baseline; 869 participated in all waves). We measured individual negative attitudes toward people with HIV ("public stigma") and perceptions of negative attitudes among others ("perceived stigma") using parallel 15-item scales. We estimated mean stigma scores, computed inequality measures at each wave, and decomposed