Health literacy, knowledge of HIV/AIDS, and public stigma among general citizens of Japan: an online cross-sectional survey

Abstract

Abstract Background This study aimed to clarify the relationship between health literacy, knowledge of human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS), and public stigma toward people living with HIV/AIDS (PLWH) in the general Japanese population. Methods We conducted an online cross-sectional survey targeting adults (age range: 20 s to 60 s) from among the 2.2 million registrants in Rakuten Insight from September 20 to 25, 2019. Stratified randomized sampling was performed by region, sex, and age. The study participants were 2,500 heterosexual HIV-negative adults with no acquaintances who were PLWH. Among these participants, 232 who provided incomplete responses were excluded, leaving 2,268 eligible for analysis (effective response rate: 90.7%). Results Models were compared using structural equation modeling for the relationship between health literacy (16-item version of the European Health Literacy Survey), basic knowledge about HIV/AIDS, public stigma toward HIV/AIDS, and social distance. The results indicated that health literacy scores mediated public stigma and were associated with social distance (standardized coefficient of indirect effect: –.157, p < .001). Knowledge of HIV/AIDS also affected social distance through public stigma (standardized coefficient of indirect effect: –.082, p < .001). The model fit was as follows: Tucker–Lewis index = 0.90, comparative fit index = 0.91, and root mean square error of approximation = 0.058. Conclusions These findings indicate that health literacy not only maintains and promotes individual health but also has the potential to reduce stigma toward HIV/AIDS and is more closely associated with less public stigma toward HIV/AIDS than knowledge of HIV/AIDS.