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The authors declare that they have no competing interests.
LAC significantly contributed to the acquisition, analysis, interpretation of data, the study coordination and the drafting and editing of the manuscript. SR significantly contributed to the conception and design of the study, and its coordination, and contributed to the analysis and interpretation of data and the revision of the manuscript. DNB significantly contributed to the acquisition, analysis and interpretation of data and was involved in the drafting and editing of the manuscript. MGW significantly contributed to the conception and design of the study and was involved in the revision of the manuscript. RD contributed significantly to the acquisition, analysis and interpretation of data and in the revisions of the manuscript. ER contributed significantly to the acquisition and verification of data, was also involved in the analysis and interpretation of data, and in the revision of the manuscript. SBR conceived of the study, participated in its design and coordination, and contributed to the revision of the manuscript. All authors read and approved the final manuscript.
HIV-related stigma continues to negatively impact the health and well-being of people living with HIV, with deleterious effects on their care, treatment and quality of life. A growing body of qualitative research has documented the relationship between HIV-related stigma and health. This review aims to synthesize qualitative evidence that explored the intersections of stigma and health for people with HIV.
A thematic summary was conducted that was guided by the qualitative metasummary technique developed by Sandelowski and Barraso. Literature searches yielded 8,622 references of which 55 qualitative studies were identified that illustrated HIV-related stigma in the context of health.
The metasummary classified qualitative findings into three overarching categories: conceptualizing stigma which identified key dimensions of HIV-related stigma; experiencing stigma which highlighted experiences of stigma in the health context, and managing stigma which described ways in which stigma is avoided or addressed. To better illustrate these connections, the qualitative literature was summarized into the following themes: stigma within health care settings, the role of stigma in caring for one’s health, and strategies to address HIV-related stigma in the health context. A number of health care practices were identified – some rooted in institutional practices, others shaped by personal perceptions held by practitioners – that could be stigmatizing or discriminatory towards people with HIV. There existed interconnections between enacted stigma and felt stigma that influenced health care utilization, treatment adherence, and overall health and well-being of people with HIV. Intersectional stigma also emerged as instrumental in the stigma experiences of people living with HIV. A number of strategies to address stigma were identified including social support, education, self-efficacy, resilience activities, and advocacy.
This review of the qualitative evidence indicates that HIV-related stigma within health contexts is a broad social phenomenon that manifests within multiple social spheres, including health care environments. Findings from this review indicate that future stigma research should consider the social structures and societal practices – within and outside of health care environments – that perpetuate and reinforce stigma and discrimination towards people with HIV.