HIV, migration, gender, and drug addiction: A qualitative study of intersectional stigma towards Afghan immigrants in Iran

Abstract

HIV-related stigma has been identified as a major barrier to the diagnosis, prevention, and treatment of HIV among immigrants. The intersection of HIV with other forms of stigma can lead to greater inequality in health outcomes and access to health services. This study aimed to improve the understanding of HIV stigma towards Afghan immigrants in Iran through an intersectional perspective. The data were collected using 25 semi-structured interviews with the following three groups: Afghan immigrants who were diagnosed with or at risk of HIV infection due to injection drug addiction or having multiple sexual partners (n = 8), HIV service providers (n = 8), and policymakers/managers/experts (n = 9). Thematic analysis was used for data analysis.The participants described different manifestations of stigma (internalized, anticipated, perceived, experienced stigma, and discrimination) associated with HIV and interlocked with other aspects of stigma, including migration, gender, and drug addiction. According to the results, the intersection of different layers of stigma should be taken into account while designing and implementing HIV prevention and treatment programmes. It was also recommended to conduct the necessary interventions such as comprehensive HIV education, social support, as well as peer and outreach services to reduce stigma and discrimination based on the immigrants' needs as well as cultural and social values.

Afghan mental health and psychosocial well-being: thematic review of four decades of research and interventions

“…80 Afghans with substance use problems reported being widely stigmatised in Iran. 81,82 There are reports of Afghan women, struggling to balance livelihoods and childcare responsibilities in Pakistan, giving opium to children to keep them tranquil. 80,83 For women, access to substance use services has been very low; 74 heroin use often leads them to being disowned by their families because of the shame associated with addiction.…”

Developing practical strategies to reduce addiction-related stigma and discrimination in public addiction treatment centers: a mixed-methods study protocol

“…Studies evaluating the stigma experiences of persons with SUDs are mainly qualitative in nature [ 21 , 52 , 62 , 98 , 105 , 106 ]. The present study will be one of the few studies addressing addiction-related stigma in Iran that applies a mixed-methods technique to identify suitable strategies to reduce addiction-related stigma and discrimination at PATCs from the perspective of Iranian people who use drugs.…”

“…For many years, stigma related to SUDs has posed challenges in Iran [ 51 – 53 ]. One of the most significant obstacles to improving the well-being and health of individuals with SUDs is the stigmatization and discrimination they face within the healthcare system [ 52 , 54 ]. This results in disparities in healthcare facilities, including limited availability, accessibility, and quality of services for individuals with SUDs [ 54 ].…”

“…While there have been some studies conducted in Iran to explore stigma toward individuals with SUDs, none have offered strategies or methods to mitigate stigma within public treatment settings. Although limited, existing data from small-scale qualitative studies in Iranian healthcare settings indicate the prevalence of discriminatory attitudes toward people with SUDs, manifesting as care refusal, substandard care, excessive precautions, physical distancing, humiliation, and blame [ 30 , 51 , 52 , 55 , 62 – 64 ].…”

Sexual health challenges in migrant, immigrant, and displaced populations 2022–2023

“…The WHO defines sexual health as a state of well being surrounding sexuality, and not merely the absence of disease [14 ▪ ]. Despite available cost-effective interventions and sexual health programmes for MIDP, those with precarious immigration status, migrant labourers, adolescents, Lesbian, Gay, Bisexual, Trans, Queer + (LGBTQ+) populations and those engaged in criminalised economies (e.g., sex work, illicit drug use or trade) continue to fall through the cracks of research and programming efforts [14 ▪ ,15,16 ▪ ,17,18]. MIDP often live at the intersection of multiple, coexisting vulnerabilities, including situational and personal factors (age, sex identity and expression, race, health status or disability) [19].…”