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

This study investigated anticipated stigma—the fear that HIV diagnosis or disclosure could lead to negative social consequences—among newly diagnosed adults in Johannesburg, South Africa, during the universal-test-and-treat (UTT) era. A cross-sectional survey of 652 adults (median age 33 years, 64.1% female) was conducted between October 2017 and August 2018 at four primary healthcare clinics. Anticipated stigma was assessed using a five-item scale with strong internal reliability (Cronbach’s alpha = 0.82) and categorized into “low-to-medium” and “high.” Overall, 55% of participants reported high anticipated stigma, which was more common among younger adults, men, and those in unmarried relationships. Lower levels of anticipated stigma were observed among older individuals, those with long-term or rural residence, fewer ART-related concerns, and lower perceived social support. These findings show that anticipated stigma remains widespread despite universal treatment access, highlighting the need for interventions to address stigma drivers, promote social integration, and strengthen coping skills to support engagement in HIV care.