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Background <p>Stigma remains a pervasive barrier to the health and well-being of people living with HIV (PLHIV), affecting access to treatment and care. In Nepal, discriminatory attitudes and behaviors persist across all levels, often resulting in mental distress, social isolation, and delayed care-seeking. Guided by the Intersectional Stigma Framework, this study explored how lived HIV -related stigma operates across individual, interpersonal, community, and structural levels, and how existing social and institutional mechanisms shape the lived experiences of PLHIV.</p> Methods <p>A qualitative study was conducted among 26 people living with HIV, who had been receiving antiretroviral therapy services for at least six months at Sukraraj Tropical and Infectious Disease Hospital in Kathmandu, Nepal. Participants were selected purposively. In-depth interviews were conducted using semi-structured guidelines informed by the intersectional stigma framework. Data were analyzed using R software for qualitative data analysis, and thematic analysis was employed to identify and interpret key themes.</p> Results <p>Participants reported internalized stigma characterized by shame, guilt, and psychological distress following diagnosis, often accompanied by secrecy, and self-isolation. Over time, social support and self-acceptance contributed to improved mental health and adherence to antiretroviral therapy (ART). At the interpersonal level, disclosure was limited due to fear of rejection, with some reporting abandonment by family. Community-level stigma manifested as discrimination in public settings, with some individuals facing housing displacement and public shaming. Structural stigma was reflected in healthcare facilities through breaches of confidentiality and discriminatory practices. While the provision of free ART and insurance was well-received, concerns persisted about the sustainability of these programs over time.</p> Conclusion <p>HIV-related stigma in Nepal operates through interconnected psychological, social, and institutional mechanisms that influence disclosure, treatment engagement, and social participation among PLHIV. Addressing stigma requires multi-level interventions, including strengthened confidentiality practices in healthcare, expanded psychosocial support, community education, and sustained policy commitment to ensure equitable and stigma-free HIV services.</p>

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Multi-level experiences of HIV-related stigma among people living with HIV: an institution-based qualitative study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年3月25日

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  • Dikshya Kandel,
  • Kabita Khatiwada,
  • Sudim Sharma,
  • Divya Karki,
  • Shalabh Shah,
  • Srijana Bhattarai

摘要

Background

Stigma remains a pervasive barrier to the health and well-being of people living with HIV (PLHIV), affecting access to treatment and care. In Nepal, discriminatory attitudes and behaviors persist across all levels, often resulting in mental distress, social isolation, and delayed care-seeking. Guided by the Intersectional Stigma Framework, this study explored how lived HIV -related stigma operates across individual, interpersonal, community, and structural levels, and how existing social and institutional mechanisms shape the lived experiences of PLHIV.

Methods

A qualitative study was conducted among 26 people living with HIV, who had been receiving antiretroviral therapy services for at least six months at Sukraraj Tropical and Infectious Disease Hospital in Kathmandu, Nepal. Participants were selected purposively. In-depth interviews were conducted using semi-structured guidelines informed by the intersectional stigma framework. Data were analyzed using R software for qualitative data analysis, and thematic analysis was employed to identify and interpret key themes.

Results

Participants reported internalized stigma characterized by shame, guilt, and psychological distress following diagnosis, often accompanied by secrecy, and self-isolation. Over time, social support and self-acceptance contributed to improved mental health and adherence to antiretroviral therapy (ART). At the interpersonal level, disclosure was limited due to fear of rejection, with some reporting abandonment by family. Community-level stigma manifested as discrimination in public settings, with some individuals facing housing displacement and public shaming. Structural stigma was reflected in healthcare facilities through breaches of confidentiality and discriminatory practices. While the provision of free ART and insurance was well-received, concerns persisted about the sustainability of these programs over time.

Conclusion

HIV-related stigma in Nepal operates through interconnected psychological, social, and institutional mechanisms that influence disclosure, treatment engagement, and social participation among PLHIV. Addressing stigma requires multi-level interventions, including strengthened confidentiality practices in healthcare, expanded psychosocial support, community education, and sustained policy commitment to ensure equitable and stigma-free HIV services.