Perception of Intersectional Stigma Among Adolescents Living with HIV in Uganda

Background and Purpose: Adolescents, ages 10-24, constitute a growing share of people living with HIV (YPLHIV), with half a million (460,000) infected globally in 2019 alone¹. Each week, an estimated 567 youth in Uganda are HIV infected, 64% of whom are girls and young women¹. The Uganda AIDS Commission⁷estimates that if these trends continue, Uganda’s HIV burden will increase by more than 700,000 new infections over the next five years. The literature suggests that adolescents have poorer HIV treatment outcomes in sub-Saharan Africa (SSA) because of delayed diagnosis and antiretroviral therapy (ART) due to stigma². Central to HIV stigma in Uganda is fear, misinformation, blame and shame, legal precarity, and cultural norms that promote stigma³. Stigma, therefore, is a significant barrier to HIV prevention, treatment, and care. Utilizing the stigma and discrimination framework, we conceptualize stigma to constitute overlapping drivers, facilitators, and social devaluation, intersecting with individual social identities to bring about prejudice and discrimination among YPLHIV⁴. The intersectionality paradigm⁵ suggests that stigma or experiences of social devaluation intersects with other individual identities such as being members of sexual minorities or sex workers, or women, single or partnered to bring about prejudice.

Methods: Six in-depth focus groups (N=30) qualitative data collection was conducted in March 2021 with heterogeneous, gender segregated groups consisting of perinatally and behaviorally HIV infected sex workers, drug users, and sexual minorities in Kampala, Uganda. Study procedures were conducted with the approval of respective Review Boards. Initial coding was developed by a team of four researchers, informed by literature and theory. Data were coded using the qualitative data management software, Dedoose⁶.

Results: Our focus group participants (mean age=22.35, range 19-25, standard deviation=1.94; n=30) included self-identified young men (n=16), young women (n=14), and transgender (1) youth. Most reported knowing their HIV status for the last 10 years (n=16/30; 50.1%), were unemployed (n=15/30; 48.4%) and self-rated their overall health as fair (n=14/30; 45.2%). Participants reported perceived negative opinions by other people because of their HIV status. Intersecting stigma was discussed and was attributable to sex work, sexual orientation, age, and gender in the social context of family, community, workplace, or health clinics. Thus, stigma negatively influenced adherence to seeking treatment, poor retention in care, creating challenges to achieving and maintaining viral suppression.

Conclusions and Implications: Stigma is a social phenomenon, an interplay of complex factors experienced or perceived associated with social exclusion, rejection, blame, or devaluation based on one’s identity. Coping strategies to include social support, adaptive community sensitization, and outreach are critical in addressing HIV stigma. Social workers can help address stigma-related injustices by educating the public, advocating, and crusading disinformation campaigns.