BRIDGING THE DIVIDE: A COMPARATIVE CROSS-SECTIONAL ANALYSIS OF HIV/AIDS KNOWLEDGE, ATTITUDES, AND ATTITUDINAL STIGMA AMONG URBAN AND RURAL POPULATIONS IN PAKISTAN

Abstract

Background: Pakistan is experiencing one of the fastest-growing HIV epidemics in the World Health Organization Eastern Mediterranean Region, yet awareness remains low and stigma toward people living with HIV (PLHIV) remains pervasive. A pronounced urban–rural divide is thought to impede effective prevention and care, but quantitative comparisons remain limited.

Objective: To compare HIV/AIDS knowledge, attitudes, and attitudinal stigma between urban and rural populations in Pakistan and to identify sociodemographic predictors of these outcomes.

Methods: A cross-sectional survey was conducted between January and March 2025 among 1,200 adults selected by stratified random sampling: 600 from three major urban centres (Lahore, Karachi, Islamabad) and 600 from rural districts of Punjab, Khyber Pakhtunkhwa, and Sindh. A pretested, structured, interviewer-administered questionnaire measured knowledge, attitudes, and stigma. Group differences were assessed using chi-square tests and independent t-tests; multivariable logistic regression identified independent predictors of adequate knowledge and high stigma.

Results: Urban respondents demonstrated substantially higher HIV knowledge than rural respondents across all domains, including correct knowledge of transmission (72.0% vs 38.0%; p < 0.001) and prevention (66.7% vs 30.0%; p < 0.001). Urban respondents held markedly more accepting attitudes (acceptance of PLHIV in society: 86.7% vs 33.3%; p < 0.001), whereas rural respondents endorsed stigmatising beliefs far more frequently (HIV as punishment for immoral behaviour: 66.7% vs 25.0%; support for discrimination: 75.0% vs 21.7%; both p < 0.001). In adjusted models, rural residence, lower educational attainment, and male gender independently predicted inadequate knowledge and elevated stigma.

Conclusions: A wide and statistically significant urban–rural gap exists in HIV knowledge, attitudes, and stigma in Pakistan, structured by education and gender. Closing this gap requires culturally tailored, low-literacy-appropriate education, healthcare-worker sensitisation, and community-led anti-stigma programming concentrated in rural districts. Such equity-focused action is essential to advance Pakistan toward the UNAIDS 95–95–95 targets and Sustainable Development Goal 3.3.