HIV stigma beliefs and unprotected sex among teenagers and young adults in sub-Saharan Africa: The moderating role of mass media exposure.

Despite significant advances in the fight against HIV in sub-Saharan Africa, health experts remain concerned about new infections and risky sexual behavior among teenagers & young adults (T&YAs). These concerns have spurred efforts to buttress a voluminous literature on the social determinants of risky sexual behavior in Africa. Absent from this flurry of new scholarship is a consistent focus on associations between HIV stigma beliefs and risky sexual behavior, especially among T&YAs. Alongside health professionals' concerns about sexual behaviors is growing alarm about a dramatic expansion of sexual content in African mass media markets, which experts suspect may lead to T&YA risky sexual behavior. Yet, little work using multi-country data has confirmed whether mass media exposure increases the likelihood of risky sexual behavior. We fill these two gaps in the literature using a Demographic and Health Survey sample of unpartnered sub-Saharan African people, ages 15-24, in 30 countries. With this sample, we examine the direct relationships between HIV stigma beliefs, mass media exposure, and unprotected sex. We also explore whether the effect of stigma beliefs on unprotected sex is moderated by individual and regional-level exposure to mass media content. We first find that the effect of HIV stigma beliefs is harmful or associated with increases in the probability of unprotected sex. Second, contrary to past findings, individual-level mass media exposure is protective, or associated with declines in the likelihood of unprotected sex. Third, the harmful effect of stigma attitudes is weakest when individual and regional-level mass media exposure are low, but strongest when individual and regional-level mass media exposure are high. These findings suggest that stigma beliefs can shape the sexual behaviors of African T&YAs in counterintuitive ways. They also show that mass media exposure can be simultaneously protective and harmful for this population.