"I Feel Contaminated in Some Way": Stigma, Mental Health, and Suicidality Among Sexual and Gender Minority Young People Living with HIV in Lima, Peru

Background and Purpose:
Sexual and gender minority (SGM) young people living with HIV (LWH) in Peru face profound mental health challenges, shaped by intersecting forms of stigma, marginalization, and systemic neglect. While the HIV care infrastructure in Peru offers accessible, low-cost treatment, less attention has been given to the psychological toll of living with HIV in a context where discrimination based on sexual orientation and gender identity remains pervasive. This study explores how SGM young people living with HIV in Lima, Peru navigate intersectional stigma and how it shapes their mental well-being, including experiences of suicidality amid family rejection, negative healthcare interactions, and broader social isolation.

Methods:
This qualitative study draws from in-depth interviews with SGM young people (n=20) aged 18–29 who are LWH in Lima, Peru. Participants were recruited through LGBTIQ+ community organizations and networks using purposive and snowball sampling. Interviews were conducted in Spanish, transcribed, and analyzed using reflexive thematic analysis informed by constructivist grounded theory and intersectionality. Coding focused on themes of stigma (enacted, internalized, anticipated), emotional well-being, and engagement with healthcare services. Participants also completed an identity mapping activity that helped contextualize identity-based stressors.

Results:
Many participants shared experiences of deep emotional distress and suicidality, particularly around the time of their HIV diagnosis. For some, these feelings were exacerbated by a lack of emotional support from family or providers, internalized blame, or fears of long-term social exclusion. Across these accounts, stigma, whether anticipated, enacted, or internalized, was a central thread shaping participants’ mental health trajectories. Abandoning HIV treatment was described by some as a method for attempting suicide. Even those actively engaged in HIV care reported ongoing mental health challenges, suggesting that adherence does not equate to mental wellness. At the same time, the study identified moments of resistance and coping, such as forging affirming friendships, or leaning on family (biological and chosen) for support. Disclosure of HIV status, though rare, sometimes led to unexpected support from peers or even employers, which improved participants’ sense of safety and belonging.

Conclusions and Implications:
This study highlights the urgent need to integrate mental health care into HIV services for SGM young people in Peru. While biomedical treatment is largely accessible, mental well-being remains fragile, particularly soon after initial diagnosis. Findings suggest that suicidality is not only linked to individual coping but also to broader structural and relational dynamics, including stigma, loneliness, and a lack of culturally competent psychosocial support. There is a need for community-rooted and identity-affirming mental health interventions that recognize the intersecting pressures SGM young people LWH face. Future work should explore how regional, gender, and class-based differences shape risk and resilience across the HIV care continuum.