Purpose: AIDS stigma obstructs comprehensive HIV prevention and HIV/AIDS care worldwide, including in the West Indies where national epidemics are growing rapidly. This qualitative research sought to contextualize and compare multilevel appraisals of AIDS stigma in health and social services in Trinidad & Tobago and Grenada.

Methods: We conducted eight focus groups (n=51) of people living with HIV/AIDS (PLHA), families and caretakers of PLHA, and health service providers. Using semi-structured group discussions, we explored 1) social constructions of AIDS and PLHA; 2) reaction to PLHA by families, religious groups, and neighbors; 3) conduct toward PLHA by service providers; 4) manifestations of AIDS stigma in service provision or receipt; and, 5) action needed to reduce AIDS stigma. Digitally recorded data were transcribed and then verified by West Indian research associates. In addition, we interviewed 12 key informants from governmental and nongovernmental organizations.

Content analysis of focus group transcripts was conducted with a quasi-deductive approach to verifying the transference of propositions about the expression of stigma from Western contexts (described in the extant literature in social work, public health, and medicine) to West Indian experience. We used Atlas.ti to facilitate content analysis in three stages. First, we explored indigenous concepts with inductive open coding. Second, we compared them to our literature-informed themes. Finally, selective coding was used to compare experiences across the two countries and between service recipients and providers. To enhance quality and credibility of data analysis and interpretation, we employed several types of triangulation. We used field notes from interviews with key informants to check for consistency and used multiple analysts, including researchers from the West Indies. We also contrasted these findings with those from quantitative data from workshops with service providers.

Results: PLHA feel scorned by service providers and are socially constructed to be physical and social contagions, especially when they are perceived to be gay or bisexual or using drugs. Although cases of extreme cruelty or violence were not reported, PLHA and their family caregivers reported being ostracized within neighborhood and religious communities. PLHA and service providers identified passive neglect and active refusal by hospital or clinic staff to provide direct care to PLHA. Institutional practices for safeguarding patient confidentiality are perceived as insufficient or marginally enforced. Service providers are aware of institutional practices that stigmatize PLHA, but struggle to provide empathic and compassionate care given their personal fears about casual HIV transmission and judgmental feelings.

Implications: Anti-stigma social marketing is being mounted in regional campaigns in the Caribbean to increase willingness to be tested and to reduce isolation and shame. Contrary to perceptions in the U.S., medical treatment for HIV/AIDS is available in the West Indies. However, service providers recognize there is much work to do to reduce their stigmatizing attitudes and behaviors so the public will access HIV testing and identified PLHA will present for treatment and seek support for adhering to complicated pharmaceutical regimens. Implications for interventions reducing HIV/AIDS provider stigma across diverse cultural contexts are proposed.