Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic

Abstract

HIV-related stigma can affect health by compromising coping and social support. Gender differences in stigma experiences and social support are underexplored, particularly in the Caribbean. We conducted semi-structured interviews (N = 32) with patients at two HIV clinics in the Dominican Republic. Transcripts were coded using qualitative content analysis (deductive and inductive approaches) to identify themes regarding stigma experiences and social support, which were then compared across men and women participants to identify gender differences. While both men and women described experienced stigma, including verbal abuse, men’s experience of stigma were subtler and women described outright rejection and instances of physical violence, including intimate partner violence. Both men and women described job discrimination, but women described severe disempowerment as well as permanent loss of income and/or employment whereas men described temporary changes in employment and /or decrease in income. Men and women described modifying behavior due to anticipated stigma, but only women discussed isolating themselves and discomfort taking HIV medication in front of others. Regarding internalized stigma, both men and women described shame, guilt, and depression over their HIV status, though these experiences were more common among women. Women’s experiences prevented health care seeking and included suicidality, while men sometimes blamed women for their HIV status and expressed a desire to “move on” and “look ahead.” Both men and women described receiving financial support from family and friends, community support from neighbors, governmental support, and support from other people living with HIV. Women most frequently discussed receiving support from family and friends and using religiosity to cope, whereas men referenced general family support and government benefits and were less forthcoming about personal relationships and social networks, oftentimes not disclosing HIV status to others. The social context of HIV-related stigma affects women and men differently with physical and mental health impacts and may require distinct mitigation approaches.

Defining HIV-Related Social Support: What Types of Social Support Do People With HIV Need?

“…Previous studies showed that PWH's discrimination came from many sources, such as their family members, health care providers, colleagues, and friends. (Celeste-Villalvir et al, 2023; Ingabire et al, 2023; Padilla et al, 2022). This discriminatory environment also leads to internalized discrimination among PWH (Ingabire et al, 2023).…”

“…Under these circumstances, the impact of HIV on crucial life milestones can significantly influence the decision-making process for PWH. They may face uncertainties when making important life choices, such as whether to get married and have children (Gigstad et al, 2023; Guo et al, 2022); whether to disclose their HIV status to friends, family, sexual partners, and others (Yang et al, 2023); and whether to change jobs or avoid jobs with HIV testing involved in pre-employment or annual medical examination (Celeste-Villalvir et al, 2023). Effective appraisal support requires that support providers not influence PWH's decision-making with personal subjective tendencies and preferences.…”

Involvement of Personality and Health Status in the Psychological Wellbeing of Subjects with Chronic Disease

“…In this context, we emphasize HIV infection, a highly complex pathology in which individuals must cope with numerous physiological, sociocultural, economic, and psychological stressors. HIV-positive patients face social stigma, experience increased discrimination, and have reduced social support [8][9][10]. All of these factors can significantly affect the mental health of affected individuals.…”

Changes in HIV internalized and experienced stigmas and social support after an urban gardens and peer nutritional counseling intervention among people with HIV and food insecurity in the Dominican Republic

“…These group and peer aspects of our intervention were emphasized because the lack of social support and fear of rejection are barriers to ART adherence in the DR 35,36 and PLHIV living there report high levels of HIV-related discrimination (eg, verbal and physical aggression, employment-related HIV testing, and termination or denial of work), resulting in psychosocial burden. [37][38][39][40][41][42] Our intervention aimed to ameliorate internalized HIV stigma as PLHIV interacted with one another and through improved relations with others. In addition, we posited that as participants contributed to household and community food security as a result of the intervention, internalized and experienced stigmas would decrease and social support would increase.…”