In the context of the upcoming World AIDS Day 2024, it is crucial to raise awareness that stigma and discrimination associated with HIV/AIDS have been identified by both the World Health Organization and UNAIDS as major obstacles to ending the HIV/AIDS pandemic, particularly in light of advances in treatment since the introduction of antiretroviral therapy. Our recent study examines how different minority statuses—such as gender, sexual orientation and AIDS diagnosis—interact to shape the stigma experienced by people living with HIV (PLWH).
We formulated three hypotheses. First, we assessed the individual impact of each minority status (gender, sexual orientation, and HIV diagnosis) on stigma. Next, we explored whether combinations of two minority statuses amplify stigma. Finally, we analyzed the effect of having all three statuses simultaneously on overall stigma.
The study involved 663 adults with a medically confirmed diagnosis of HIV infection who were undergoing antiretroviral treatment. Our findings provided partial support for our first hypothesis: overall, sexual orientation significantly influenced perceived stigma, with heterosexual PLWH reporting unexpectedly higher levels of stigma than their LGBTQ counterparts. This result, although contrary to previous research, reveals shifting dynamics in the HIV/AIDS landscape. It challenges long-standing societal perceptions that have historically associated HIV infection primarily with men and homosexual orientation. Rather, heterosexual individuals with HIV, when they constitute a minority within this population, may experience additional stigma beyond those faced by PLWH in general.
A closer examination of gender differences in our second hypothesis highlights that heterosexual women report the highest levels of stigma, whereas heterosexual men do not exhibit a significant association between stigma and sexual orientation. This disparity becomes even more pronounced when considering the presence of an AIDS diagnosis in our analysis. Among women diagnosed with AIDS, those with a heterosexual orientation experience the most intense levels of stigma.
Additionally, examining different dimensions of stigma reveals that disclosure-related stigma—the fear of revealing one’s HIV-positive status—is particularly influenced by the intersections of minority statuses.
These findings open new avenues for minority stress theory, suggesting that stigmatized groups experience heightened social stress due to their minority status in society. Our results indicate that HIV/AIDS stigma is not shaped solely by individual minority statuses but by their complex interactions. This complexity reveals that perceived stigma varies depending on whether an individual holds a general minority status (in comparison to the general population) or a relative minority status (in relation to the HIV-positive population within a specific country or community). Furthermore, the latter status should always be contextualized within the epidemiological landscape of the person's place of daily living environment.
Understanding these dynamics is crucial for reducing stigma thereby enhancing support for PLWH and decreasing anxiety surrounding HIV testing.