Stigma Attitudes Toward HIV/AIDS From 2011 Through 2023 in Japan: Retrospective Study in Japan.

backgroundStigma associated with HIV/AIDS continues to be a major barrier to prevention, management, and care. HIV stigma can negatively influence health behaviors. Surveys of the general public in Japan also demonstrated substantial gaps in knowledge of HIV/AIDS. Tweets from the social networking service X (formerly known as Twitter) have been studied to identify stigmas in other disorders but have not yet been used to study HIV stigma in Japan.

objectiveThe aim of the study is to examine the variations in stigma related to HIV over an extended period using tweets from X and to investigate the stigma toward people with HIV associated with various demographic segments.

methodsJapanese tweets from X related to HIV/AIDS were retrospectively collected; the phase 1 feasibility study collected tweets from 2011, 2014, and 2017, and the phase 2 analysis included tweets from each third year from 2011 through 2023. Individual tweets were labeled with the messages they conveyed (stigma and corresponding antistigma types included labels, marks, responsibility, peril, insults, and fear; tweets without stigma or antistigma messages were considered general education or neutral) along with demographic characteristics and locations; phase 1 results were used to develop a machine learning model to apply in phase 2. The labeled data from phase 2 were used to answer research questions concerning yearly changes in HIV stigma and proportions of stigma across population segments.

resultsA total of 2,016,826 tweets related to HIV/AIDS were identified over the study period; 1,648,556 (81.7%) were from individual accounts, with the remainder from organizational accounts. In total, 574,687 (28.5%) tweets indicated stigma attitudes, while 1,119,852 (55.5%), 207,320 (10.3%), and 114,967 (5.7%) showed neutral, antistigma, or general education attitudes, respectively. Tweets including peril, fear, or insult comprised 502,134 (87.4%) of tweets with stigma. The greatest numbers of tweets were made by people in their 20s, whereas people in their 20s and 60s had the greatest proportions of tweets with stigma (n=9650, 35.3% and n=558, 34.5%, respectively). Peril and fear made up 5819 (60.3%) of stigma tweets from people in their 20s. The proportion of tweets with stigma (n=59,719, 20.5% in 2017) increased notably during the COVID-19 pandemic (n=217,512, 31.4% in 2020, and a similar n=175,647, 33.9% in 2023). Tweets from health care practitioners had 1.68 times the odds of having antistigma messages versus those from others.

conclusionsThis study contributes to the understanding of HIV stigma in Japan and shows the usefulness of social media for studying stigma. The extent and type of HIV stigma changed from before to after the COVID-19 pandemic. These results can be used to develop future activities and educational programs to combat HIV-related stigma.