Social and behavioral consequences of mask policies during the COVID-19 pandemic.

Mandatory and voluntary mask policies may have yet unknown social and behavioral consequences related to the effectiveness of the measure, stigmatization, and perceived fairness. Serial cross-sectional data (April 14 to May 26, 2020) from nearly 7,000 German participants demonstrate that implementing a mandatory policy increased actual compliance despite moderate acceptance; mask wearing correlated positively with other protective behaviors. A preregistered experiment (n = 925) further indicates that a voluntary policy would likely lead to insufficient compliance, would be perceived as less fair, and could intensify stigmatization. A mandatory policy appears to be an effective, fair, and socially responsible solution to curb transmissions of airborne viruses.

Spillover Effects of Medicare's Voluntary Bundled Payments for Joint Replacement Surgery to Patients Insured by Commercial Health Plans.

BACKGROUND: Under the Bundled Payments for Care Improvement (BPCI) program, bundled paymtents for lower-extremity joint replacement (LEJR) are associated with 2% to 4% cost savings with stable quality among Medicare fee-for-service beneficiaries. However, BPCI may prompt practice changes that benefit all patients, not just fee-for-service beneficiaries. OBJECTIVE: To examine the association between hospital participation in BPCI and LEJR outcomes for patients with commercial insurance or Medicare Advantage (MA). DESIGN: Quasi-experimental study using Health Care Cost Institute claims from 2011 to 2016. SETTING: LEJR at 281 BPCI hospitals and 562 non-BPCI hospitals. PATIENTS: 184 922 patients with MA or commercial insurance. MEASUREMENTS: Differential changes in LEJR outcomes at BPCI hospitals versus at non-BPCI hospitals matched on propensity score were evaluated using a difference-in-differences (DID) method. Secondary analyses evaluated associations by patient MA status and hospital characteristics. Primary outcomes were changes in 90-day total spending on LEJR episodes and 90-day readmissions; secondary outcomes were postacute spending and discharge to postacute care providers. RESULTS: Average episode spending decreased more at BPCI versus non-BPCI hospitals (change, -2.2% [95% CI, -3.6% to -0.71%]; P = 0.004), but differences in changes in 90-day readmissions were not significant (adjusted DID, -0.47 percentage point [CI, -1.0 to 0.06 percentage point]; P = 0.084). Participation in BPCI was also associated with differences in decreases in postacute spending and discharge to institutional postacute care providers. Decreases in episode spending were larger for hospitals with high baseline spending but did not vary by MA status. LIMITATION: Nonrandomized studies are subject to residual confounding and selection. CONCLUSION: Participation in BPCI was associated with modest spillovers in episode savings. Bundled payments may prompt hospitals to implement broad care redesign that produces benefits regardless of insurance coverage. PRIMARY FUNDING SOURCE: Leonard Davis Institute of Health Economics at the University of Pennsylvania.

Required and Voluntary Occupational Use of Hazard Controls for COVID-19 Prevention in Non-Health Care Workplaces - United States, June 2020.

Certain hazard controls, including physical barriers, cloth face masks, and other personal protective equipment (PPE), are recommended to reduce coronavirus 2019 (COVID-19) transmission in the workplace (1). Evaluation of occupational hazard control use for COVID-19 prevention can identify inadequately protected workers and opportunities to improve use. CDC's National Institute for Occupational Safety and Health used data from the June 2020 SummerStyles survey to characterize required and voluntary use of COVID-19-related occupational hazard controls among U.S. non-health care workers. A survey-weighted regression model was used to estimate the association between employer provision of hazard controls and voluntary use, and stratum-specific adjusted risk differences (aRDs) among workers reporting household incomes <250% and ≥250% of national poverty thresholds were estimated to assess effect modification by income. Approximately one half (45.6%; 95% confidence interval [CI] = 41.0%-50.3%) of non-health care workers reported use of hazard controls in the workplace, 55.5% (95% CI = 48.8%-62.2%) of whom reported employer requirements to use them. After adjustment for occupational group and proximity to others at work, voluntary use was approximately double, or 22.3 absolute percentage points higher, among workers who were provided hazard controls than among those who were not. This effect was more apparent among lower-income (aRD = 31.0%) than among higher-income workers (aRD = 16.3%). Employers can help protect workers from COVID-19 by requiring and encouraging use of occupational hazard controls and providing hazard controls to employees (1).

Voluntary private health insurance demand determinants and risk preferences: Evidence from SHARE.

The demand for voluntary private health insurance (VPHI) in universal coverage health systems in Europe raises some questions. The aim of this paper is to determine the factors that explain the decision to purchase VPHI, to analyse the role of individual risk attitudes and self-assessed health (SAH) in purchasing VPHI, to explore the factors that explain individual risk preferences, and to test how SAH relates to those preferences. To achieve this aim, two recursive simultaneous probits are estimated using data collected by SHARE, wave 6. The main results indicate that people who are more satisfied with the health system coverage are more likely to buy VPHI; SAH is negative correlated with VPHI, but being a risk taker contributes to that decision; however, being a risk taker is positively influenced by good health status. This paper contributes to the discussion on the role of SAH and risk preferences in the decision to buy VPHI. It brings new insights for the health insurance companies and for health policy makers. HIGHLIGHTS: People who are more satisfied with the health system coverage are more likely to buy voluntary private health insurance. The longer the planning horizon assumed by individuals, the greater the likelihood they are risk takers. People reporting being risk takers are more likely to have taken out voluntary private health insurance. Self-assessed health influences the decision to buy voluntary private health insurance in two ways: a direct one, where better health lowers the odds of having insurance, and an indirect one through risk taking, which increases the odds of having insurance. Contributions of this work are mainly for health policy makers and insurance companies.

Curriculum requirements and subsequent civic engagement: is there a difference between 'forced' and 'free' community service?

Despite figures showing the growth of mandatory community service programmes, there is mixed empirical evidence of their effectiveness. This paper addresses the relationship of mandated community service to one of its purported aims: subsequent volunteerism. It compares current volunteerism among four university student cohorts: those doing no service in secondary school, those volunteering with no requirement, those volunteering both before and after the introduction of a requirement, and those introduced to service through a requirement. The analysis indicates that (1) students who were introduced to service through a mandated programme exhibit current levels of engagement no greater than non-volunteers; (2) this relationship stems largely from the different service experiences of our four cohorts and relates to the fact that service satisfaction and duration, as well as background variables account for current levels of civic engagement. The findings suggest that mandatory service programmes might well be failing the very population they seek to target, particularly in weaker, less structured programmes.

Income inequality in uptake of voluntary versus organised breast cancer screening: evidence from the British Household Panel Survey.

BACKGROUND: This paper measures income-related inequality in uptake of breast cancer screening among women before and after a policy change to extend the screening programme to women aged 65 to 70. Prior to programme expansion women aged 50 to 64 were invited for screening under the national cancer screening programme in England and Wales whereas women in the 65 to 70 age cohort could elect to be screened by personally organising a screen. This will give a deeper insight into the nature of inequality in screening and the impact of policies aimed at widening the access related to age on inequality of uptake. METHODS: Taking advantage of this natural experiment, inequality is quantified across the different age cohorts and time periods with the use of concentration indices (CI). Using data from the British Household Panel Survey, information on screening attendance, equivalised household income and age was taken for the three years prior to the programme expansion and the three years immediately following the policy change. RESULTS: Results show that following the expansion, inequality significantly reduced for the 50-64 age group, prior to the expansion there was a pro-rich inequality in screening uptake. There is also evidence of a reduction in income inequality in screening uptake among those aged 65 to 70 and an increase in the number of women attending screening from this older age cohort. CONCLUSIONS: This indicates that an organised breast screening programme is likely to reduce income related inequality over a screening programme where women must organise their own screen. This is important when breast screening is one of the main methods used to detect breast cancer at an earlier stage which improves outcomes for women and reduces treatment costs.

Examining Relationships among Choice, Affect, and Engagement in Summer STEM Programs.

Out-of-school time programs focused on science, technology, engineering and mathematics (STEM) have proliferated recently because they are seen as having potential to appeal to youth and enhance STEM interest. Although such programs are not mandatory, youth are not always involved in making the choice about their participation and it is unclear whether youth's involvement in the choice to attend impacts their program experiences. Using data collected from experience sampling, traditional surveys, and video recordings, we explore relationships among youth's choice to attend out-of-school time programs (measured through a pre-survey) and their experience of affect (i.e., youth experience sampling ratings of happiness and excitement) and engagement (i.e., youth experience sampling ratings of concentration and effort) during program activities. Data were collected from a racially and ethnically diverse sample of 10-16 year old youth (n = 203; 50% female) enrolled in nine different summer STEM programs targeting underserved youth. Multilevel analysis indicated that choice and affect are independently and positively associated with momentary engagement. Though choice to enroll was a significant predictor of momentary engagement, positive affective experiences during the program may compensate for any decrements to engagement associated with lack of choice. Together, these findings have implications for researchers, parents, and educators and administrators of out-of-school time programming.

A Quarter Century of Participation in School-Based Extracurricular Activities: Inequalities by Race, Class, Gender and Age?

Extracurricular activity participation is linked to positive development, but it is also a setting for inequality. Using a quarter century of data from Monitoring the Future (N = 593,979; 51% female; 65% non-Hispanic white; 13% non-Hispanic black; 12% Hispanic; 4% non-Hispanic Asian/Pacific Islander; 7% other race), this article documents patterns and trends in school-based extracurricular participation by race, social class, gender, and age, and their links to academic and substance use outcomes. Findings reveal differences by race and confirm a division by social class that has worsened over time. Further, girls are gaining on boys and surpass them in some types of school-based activities. Participation is linked to better academic outcomes and less substance use, affirming the importance of redressing the inequalities revealed.

Associations with HIV testing in Uganda: an analysis of the Lot Quality Assurance Sampling database 2003-2012.

Beginning in 2003, Uganda used Lot Quality Assurance Sampling (LQAS) to assist district managers collect and use data to improve their human immunodeficiency virus (HIV)/AIDS program. Uganda's LQAS-database (2003-2012) covers up to 73 of 112 districts. Our multidistrict analysis of the LQAS data-set at 2003-2004 and 2012 examined gender variation among adults who ever tested for HIV over time, and attributes associated with testing. Conditional logistic regression matched men and women by community with seven model effect variables. HIV testing prevalence rose from 14% (men) and 12% (women) in 2003-2004 to 62% (men) and 80% (women) in 2012. In 2003-2004, knowing the benefits of testing (Odds Ratio [OR] = 6.09, 95% CI = 3.01-12.35), knowing where to get tested (OR = 2.83, 95% CI = 1.44-5.56), and secondary education (OR = 3.04, 95% CI = 1.19-7.77) were significantly associated with HIV testing. By 2012, knowing the benefits of testing (OR = 3.63, 95% CI = 2.25-5.83), where to get tested (OR = 5.15, 95% CI = 3.26-8.14), primary education (OR = 2.01, 95% CI = 1.39-2.91), being female (OR = 3.03, 95% CI = 2.53-3.62), and being married (OR = 1.81, 95% CI = 1.17-2.8) were significantly associated with HIV testing. HIV testing prevalence in Uganda has increased dramatically, more for women than men. Our results concurred with other authors that education, knowledge of HIV, and marriage (women only) are associated with testing for HIV and suggest that couples testing is more prevalent than other authors.

Vaccination coverage in French 17-year-old young adults: an assessment of mandatory and recommended vaccination statuses.

We aimed to assess vaccination coverage (VC) in 17-year-old French young adults (YAs) participating in one mandatory Day of Defence and Citizenship (DDC). Between June 2010 and May 2011, YAs participating in 43 randomly selected mandatory sessions of the DDC programme in Poitou-Charentes (France) were asked to provide their personal vaccination record. Tetanus, diphtheria, polio, hepatitis B, Haemophilus influenzae b, pertussis, measles, mumps and rubella vaccination status were assessed at ages 2, 6, 13 and 17 years. Of 2610 participants, 2111 (81%) supplied documents for evaluation. Of these, 1838 (87%, M:F sex ratio 0·96) were aged 17 years (9% of the global population of this age in the area). The assessment of the 17-year-olds demonstrated the following rates of complete vaccination: diphtheria-tetanus-polio 83%; measles, mumps and rubella 83%; pertussis 69%; H. influenzae b 61%; human papillomavirus 47%; and hepatitis B 40%. At age 6 years, only 46% had received two doses of the vaccine against measles. The YAs were not aware of their status but were in favour of vaccination. VC in YAs is insufficient, particularly for hepatitis B, pertussis and measles. Combined vaccines and the simplification of vaccination schedules should improve VC. Preventive messages should focus on YAs.

Factors influencing the uptake of voluntary HIV counseling and testing in rural Ethiopia: a cross sectional study.

BACKGROUND: Voluntary counseling and testing (VCT) has been one of the key policy responses to the HIV/AIDS epidemic in Ethiopia. However, the utilization of VCT has been low in the rural areas of the country. Understanding factors influencing the utilization of VCT provides information for the design of context based appropriate strategies that aim to improve utilization. This study examined the effects of socio-demographic and behavioral factors, and health service characteristics on the uptake of VCT among rural adults in Ethiopian. METHODS/DESIGN: This study was designed as a cross sectional study. Data from 11,919 adults (6278 women aged 15-49 years and 5641 men aged 15-59 years) residing in rural areas of Ethiopia who participated in a national health extension program evaluation were used for this study. The participants were selected from ten administrative regions using stratified multi-stage cluster sampling. Multivariate logistic regression analysis was performed accounting for factors associated with the use of VCT service. RESULTS: Overall, men (28 %) were relatively more likely to get tested for HIV than women (23.7 %) through VCT. Rural men and women who were young and better educated, who perceived having small risk of HIV infection, who had comprehensive knowledge, no stigmatization attitude and discussed about HIV/AIDS with their partner, and model-family were more likely to undergone VCT. Regional state was also strongly associated with VCT utilization in both men and women. Rural women who belonged to households with higher socio-economic status, non-farming occupation, female-headed household and located near health facility, and who visited health extension workers and participated in community conversation were more likely to use VCT. Among men, agrarian lifestyle was associated with VCT use. CONCLUSIONS: Utilization of VCT in the rural communities is low, and socio-economic, behavioral and health service factors influence its utilization. For increasing the utilization of VCT service in rural areas, there is a need to target the less educated, women, poor and farming families with a focus on improving knowledge and reducing HIV/AIDS related stigma. Strategy should include promoting partner and community conversations, accelerating model-family training, and using alternative modes of testing.

Detrimental effects of introducing partial compulsory vaccination: experimental evidence.

BACKGROUND: During outbreaks of vaccine-preventable diseases, compulsory vaccination is sometimes discussed as a last resort to counter vaccine refusal. Besides ethical arguments, however, empirical evidence on the consequences of making selected vaccinations compulsory is lacking. Such evidence is needed to make informed public health decisions. This study therefore assesses the effect of partial compulsory vaccination on the uptake of other voluntary vaccines. METHOD: A total of 297 (N) participants took part in an online experiment that simulated two sequential vaccination decisions using an incentivized behavioural vaccination game. The game framework bases on epidemiological, psychological and game-theoretical models of vaccination. Participants were randomized to the compulsory vaccination intervention (n = 144) or voluntary vaccination control group (n = 153), which determined the decision architecture of the first of two decisions. The critical second decision was voluntary for all participants. We also assessed the level of anger, vaccination attitude and perceived severity of the two diseases. RESULTS: Compulsory vaccination increased the level of anger among individuals with a rather negative vaccination attitude, whereas voluntary vaccination did not. This led to a decrease in vaccination uptake by 39% in the second voluntary vaccination (reactance). CONCLUSION: Making only selected vaccinations compulsory can have detrimental effects on the vaccination programme by decreasing the uptake of voluntary vaccinations. As this effect occurred especially for vaccine hesitant participants, the prevalence of vaccine hesitancy within a society will influence the damage of partial compulsory vaccination.

Factors influencing the uptake of Voluntary HIV Counseling and Testing among secondary school students in Arusha City, Tanzania: a cross sectional study.

BACKGROUND: Voluntary HIV counseling and testing (VCT) is a key strategy towards HIV prevention yet, the uptake of VCT services among young people remains low. This study determined the factors that influence the uptake of VCT among secondary school students in Arusha City, Tanzania. METHODS: A cross sectional study using quantitative methods was conducted. A multi-stage sampling method was applied to randomly select the secondary schools. Stratification, random and systematic sampling techniques were used to identify the study participants. Interviews were conducted using structured questionnaires. Data analysis was done using statistical package for social sciences version 16. Analytical statistics were done using odds ratio to measure strength of association between VCT uptake and independent variables. Association with p-value < 0.05 was considered significant. Binary logistic regression was used to identify predictors of VCT uptake. RESULTS: Of 400 study participants, 50.5% were male and 49.5% were female. 93.5% of the respondents were aware of the VCT services, 79.1% had high knowledge on VCT services and 75.9% had positive attitude towards VCT services. On VCT uptake, only 29.3% had ever tested. VCT uptake was found to be significantly predicted by age (p = 0.003), sex (p < 0.001), religion (p < 0.001), exposure to VCT information from a VCT centre (p < 0.001) and type of school ownership (p < 0.013). CONCLUSION: Despite high knowledge on VCT services, the uptake of VCT among secondary school students was found to be low. The uptake of VCT was mainly found to be influenced by fear of HIV test results, knowledge and attitude on VCT services, age, education, engagement in sexual relationships, stigma and distance to the VCT centre. Integration of youth friendly VCT services in secondary schools would increase VCT uptake among secondary school students. Support and care received after knowing the test results should be clearly communicated as it helps motivate more young people towards VCT uptake and reduce stigma among them.

Factors associated with participation of Alberta dairy farmers in a voluntary, management-based Johne's disease control program.

The Alberta Johne's Disease Initiative (AJDI) is a voluntary, management-based prevention and control program for Johne's disease (JD), a wasting disease in ruminants that causes substantial economic losses to the cattle industry. Despite extensive communication about the program's benefits and low cost to participating producers, approximately 35% of Alberta dairy farmers have not enrolled in the AJDI. Therefore, the objective was to identify differences between AJDI nonparticipants and participants that may influence enrollment. Standardized questionnaires were conducted in person on 163 farms not participating and 61 farms participating in the AJDI. Data collected included demographic characteristics, internal factors (e.g., attitudes and beliefs of the farmer toward JD and the AJDI), external factors (e.g., farmers' JD knowledge and on-farm goals and constraints), as well as farmers' use and influence of various information sources. Nonparticipants and participants differed in at least some aspects of all studied categories. Based on logistic regression, participating farms had larger herds, higher self-assessed knowledge of JD, better understanding of AJDI details before participation, and used their veterinarian more often to get information about new management practices and technologies when compared with nonparticipants. In contrast, nonparticipants indicated that time was a major on-farm constraint and that participation in the AJDI would take too much time. They also indicated that they preferred to wait and see how the program worked on other farms before they participated.

Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG-5.

OBJECTIVE: To understand changes in epidemiology of maternal mortality in rural India in the context of increasing institutional deliveries and implementation of community-based interventions that can inform policies to reach MDG-5. METHODS: This study is a secondary analysis of prospectively collected community-based data of every pregnancy and its outcomes from 2002 to 2011 in a rural, tribal area of Gujarat, India as part of safe-motherhood programme implemented by voluntary organisation, SEWA Rural. The programme consisted of community-based interventions supported by a first referral unit, and promotion of institutional deliveries. For every maternal death, a verbal autopsy was conducted. The incidence rates for maternal mortality according to place, cause and timing of maternal deaths in relation to pregnancy were computed. Annual incidence rate ratios (IRR) and 95% confidence intervals, adjusted for caste and maternal education, were estimated using Poisson regression to test for linear trend in reduction in mortality during the study period. RESULTS: Thirty-two thousand eight hundred and ninety-three pregnancies, 29,817 live births and 80 maternal deaths were recorded. Maternal mortality ratio improved from 607 (19 deaths) in 2002-2003 to 161 (five deaths) in 2010-2011. The institutional delivery rate increased from 23% to 65%. The trend of falling maternal deaths was significant over time, with an annual reduction of 17% (adjusted IRR 0.83 CI 0.75-0.91, P-value <0.001). There were significant reductions in adjusted incidence rate of maternal deaths due to direct causes, during intrapartum and post-partum periods, and those which occurred at home. However, reductions in incidence of maternal deaths due to indirect causes, at hospital and during antepartum period were not statistically significant. Most maternal deaths are now occurring at hospitals and due to indirect causes. CONCLUSION: Gains in institutional deliveries and community-based interventions resulting in fewer maternal deaths due to direct causes should be maintained. However, it would be essential to now prioritize management of indirect causes of maternal mortality during pregnancy at community and hospitals for further reduction in maternal deaths to achieve MDG-5.

Predictors of voluntary HIV counselling and testing services utilization among people with disabilities in Addis Ababa, Ethiopia.

The study investigated HIV testing prevalence and factors associated with the utilization of voluntary HIV counselling and testing (VCT) services among individuals with disabilities in Addis Ababa. The analysis was based on a survey of 209 men and 203 women with disabilities, aged 15-49, who had ever heard about HIV and AIDS in four sub-cities in Addis Ababa. HIV testing prevalence was 53.2%, with no significant difference between males and females. Comprehensive HIV knowledge, living with spouse, and religious affiliations positively predicted utilization of VCT services among participants. Living with both parents and having physical or mental/intellectual disabilities were negative predictors of VCT services utilization. More research on the predictors of utilization of VCT services by gender and urban/rural divides are needed among people with disabilities.

[Voluntary work in social and health care: a critical review of assessment instruments]. / Freiwilligenengagement im Gesundheits- und Pflegebereich: Ein Critical Review über Assessmentinstrumente.

BACKGROUND: Due to an increasing need for voluntary workers in the provision of care for care-dependent people, sustainable recruiting, retention, and quality management strategies are required. In this regard, assessment instruments (AI) are helpful as a basis for obtaining information and planning. The aims of this critical review are to identify AIs in voluntary work and to analyze and critically appraise their domains, target groups, and psychometric properties. METHODS: A systematic search with an interdisciplinary emphasis was conducted in Medline, CINAHL, PsycINFO and other socioscientific databases. After the selection of identified articles, 12 research papers remained for analysis and were summarized in a critical review. RESULTS: In total, 15 AIs, 13 domains (e.g., motivation, satisfaction), and 4 target groups could be identified. The domain "motivation" and the target group "voluntary workers in hospice/palliative care" were most frequently represented. Currently, there are no instruments available which cover a broad range of domains and target groups. CONCLUSION: To support sustainability and quality of care in volunteerism, the development of new AIs is necessary.

Overpunishing is not necessary to fix cooperation in voluntary public goods games.

The fixation of cooperation among unrelated individuals is one of the fundamental problems in biology and social sciences. It is investigated by means of public goods games, the generalization of the prisoner's dilemma to more than two players. In compulsory public goods games, defect is the dominant strategy, while voluntary participation overcomes the social dilemma by allowing a cyclic coexistence of cooperators, defectors, and non-participants. Experimental and theoretical research has shown how the combination of voluntary participation and altruistic punishment-punishing antisocial behaviors at a personal cost-provides a solution to the problem, as long as antisocial punishment-the punishing of cooperators-is not allowed. Altruistic punishment can invade at low participation and pave the way to the fixation of cooperation. Specifically, defectors are overpunished, in the sense that their payoff is reduced by a sanction proportional to the number of punishers in the game. Here we show that qualitatively equivalent results can be achieved with a milder punishing mechanism, where defectors only risk a fixed penalty per round-as in many real situations-and the cost of punishment is shared among the punishers. The payoffs for the four strategies-cooperate, defect, abstain, and cooperate-&-punish-are derived and the corresponding replicator dynamics analyzed in full detail.

Changing patterns in HIV/AIDS stigma and uptake of voluntary counselling and testing services: the results of two consecutive community surveys conducted in the Western Cape, South Africa.

Voluntary counselling and HIV testing (VCT) has been associated with decreased human immunodeficiency virus (HIV) risk behaviour, but in South Africa, which has the largest HIV/acquired immune deficiency syndrome (AIDS) epidemic in the world, uptake of VCT remains low. HIV/AIDS-associated stigma has been identified as a barrier to HIV testing. This study explored changes in stigma, and VCT access in a peri-urban South African community with high HIV prevalence, following education and research interventions, as well as the introduction of a wide-scale antiretroviral therapy (ART) programme. Two cross-sectional community surveys assessing HIV knowledge, attitudes and uptake of VCT services were conducted. The first survey was performed in 2004 prior to the implementation of a community-based HIV awareness and education campaign, HIV prevention research studies and the introduction of an ART programme. The second survey was performed in 2008 after a three-year education programme, the implementation of HIV-related research studies and following the scale-up of the ART programme. The same study design was used in both the 2004 and 2008 surveys: 10% of households were randomly selected and all residents aged ≥ 14 years were invited to complete a self-administered questionnaire. Overall basic knowledge of HIV/AIDS increased from 2004 to 2008 (p=0.04) and stigmatisation towards HIV-positive individuals decreased over the same time period (p<0.001). Increasing knowledge score was significantly associated with a lower stigma score (p<0.001). Decreasing stigma score was associated with knowing someone who was HIV infected (p<0.001), or who had died from HIV/AIDS (p=0.04). The proportion of participants who had undergone HIV testing increased from 2004 to 2008 (40 vs. 70%, respectively) and, in particular, VCT increased from 26 to 43%. In adjusted analysis, participants who had undergone HIV testing were more likely to have a higher HIV knowledge score (p=0.02) and a lower stigma score (p=0.09). A reduction in levels of HIV/AIDS-associated stigma was noted in a community burdened with high HIV prevalence, as was an increase in reported VCT. These findings may be the result of a number of interventions including a wide-spread and targeted education campaign, and the "normalisation" of HIV through the availability of ART. Given the role of HIV/AIDS-associated stigma in influencing choices to access HIV testing, and the benefits associated with HIV testing, interventions to reduce stigma in communities affected by this disease should be encouraged.