UC Irvine

HIV-related stigma is a catalytic and divisive social phenomenon. It refers to undesirable attitudes and behaviors directed towards people living with HIV (PLWH). Stigma intensifies socially devalued identities and serves as a lingering impediment to effective disease response. HIV stigma is prominent across multiple contexts, including in health insurance, employment, housing, religious environments, and health care. Stigma is entrenched in poor knowledge, value-laden judgments, and insufficient contact with PLWH. Examples of stigma include unnecessary preventive measures, care denial, and indiscretion with HIV status. Ethnic, gender, and sexual minorities are subjected to significant HIV-related stigmatization and these experiences have been linked to reduced testing and access, care interruptions, and mental health conditions. Women of color in the United States (US) are particularly impacted by HIV stigma, yet studies that examine personal accounts of stigma among this group are infrequent. Additionally, while the existing evidence suggests stigmatizing attitudes and behaviors among US-based health care workers and in health care settings, less work has focused on addressing these trends. The present dissertation conceptualized HIV stigma experienced by African American and Hispanic/Latina women using Interpretative Phenomenological Analysis, delineated the critical features of HIV stigma in US-based health care settings using Grounded Theory, and appraised the efficacy of a PhotoVoice-informed HIV stigma training program targeting health care workers in Southern California. The major findings of these studies were that stigma is rooted in historical mischaracterizations, amplified by patient-provider power inequalities, and triggered by fear, inadequate clinical training, inadvertent behaviors, and reduced contact with HIV patients due to overspecialization of HIV treatment. HIV-related stigma was perceived as having a destructive influence, thereby worsening self-esteem, hindering disclosure of sero-status, obstructing interpersonal and intrapersonal relationships, diminishing psychological well-being, and thwarting medical engagement. The PhotoVoice-informed intervention increased knowledge of HIV/AIDS, improved attitudes towards PLWH, and decreased observations of enacted HIV stigma in health care settings. Improving access and uptake of social support and mental health resources among PLWH, mobilizing faith-based organizations, training health care personnel, developing robust stigma reduction programs, and implementing evidence-based anti-HIV stigma policies may help reduce stigma and ameliorate health outcomes across the HIV care continuum.