Perceptions of intersectional stigma among diverse women living with HIV in the United States

Abstract

Attitudes and behavior that devalue individuals based upon their HIV status (HIV-related stigma) are barriers to HIV prevention, treatment, and wellbeing among women living with HIV. Other coexisting forms of stigma (e.g., racism, sexism) may worsen the effects of HIV-related stigma, and may contribute to persistent racial and gendered disparities in HIV prevention and treatment. Few studies examine perceptions of intersectional stigma among women living with HIV. From June to December 2015, we conducted 76 qualitative interviews with diverse women living with HIV from varied socioeconomic backgrounds enrolled in the Women's Interagency HIV Study (WIHS) in Birmingham, Alabama; Jackson, Mississippi; Atlanta, Georgia; and San Francisco, California. Interview guides facilitated discussions around stigma and discrimination involving multiple interrelated identities. Interviews were audio-recorded, transcribed verbatim, and coded using thematic analysis. Interviewees shared perceptions of various forms of stigma and discrimination, most commonly related to their gender, race, and income level, but also incarceration histories and weight. Women perceived these interrelated forms of social marginalization as coming from multiple sources: their communities, interpersonal interactions, and within systems and structures. Our findings highlight the complexity of social processes of marginalization, which profoundly shape life experiences, opportunities, and healthcare access and uptake among women living with HIV. This study highlights the need for public health strategies to consider community, interpersonal, and structural dimensions across intersecting, interdependent identities to promote the wellbeing among women living with HIV and to reduce social structural and health disparities.

A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study

“…Intersectionality examines the interaction between multiple social identities that (re)produce privilege and marginalization . Intersectionality is a particularly salient framework for understanding the HIV epidemic, as race, class and gender disparities are structural drivers of HIV An emerging field of research on intersectional stigma assesses the effects of exposure to co‐occurring forms of stigma among WLHIV . Previous Canadian research with WLHIV highlights associations between racial discrimination , HIV‐related stigma , gender discrimination and depression .…”

A qualitative study on intersectional stigma and sexual health among women on opioid substitution treatment in England: Implications for research, policy and practice

“…However, the evidence is conflicting and suggests variable relationships between different dimensions of stigma and health 4 outcomes (Varni et al, 2012;Earnshaw and Chaudoir, 2009). Drug use-related stigma often overlaps with stigma associated with other interdependent social categories (e.g., female gender, transactional sexthe exchange of sex for money and/or goods, including drugs -HIV status, race, social class, incarceration history, weight, and sexual orientation) (Mahajan et al, 2008a;Stangl et al, 2013;Chambers et al, 2015;Sangaramoorthy et al, 2017;Loutfy et al, 2012;Parker and Aggleton, 2003;Kulesza et al, 2016;King et al, 2013;Bowleg, 2008;Deacon, 2006;Deng et al, 2007;Shields, 2008;McCall, 2005;Rice et al, 2018). Personal and social identity can actually be understood as multidimensional, rather than the unidimensional product of a combination of personal attributes and belonging to certain social groups (Deaux, 1993;Rosenberg, 1988).…”

Poverty stigma is associated with suboptimal HIV care and treatment outcomes among women living with HIV in the United States

“…Additionally, low-income individuals, including those living with HIV, have reported perceived discrimination from healthcare providers based on their financial status, [27,28] which has been associated with reduced engagement in healthcare, [29] including HIV care and treatment. [18,25,30] Future research should explore how perceived discrimination from healthcare providers influences the relationship between poverty stigma and HIV care and treatment outcomes.…”