Applying the Social Ecological Model to Explore HIV-Related Stigma in the Southeastern United States: A Qualitative Study
Abstract Background: Although evidence suggests HIV-related stigma directly affects health and behaviors, we have a limited understanding of stigma’s influence beyond the individual-level. We aimed to describe HIV-related stigma and strategies to reduce it in the Southeastern U.S. within the context of the social ecological model (SEM). Methods: Qualitative surveys were distributed in-person at community events, conferences, and via email to persons affected by HIV periodically over 8 months. The final sample size included 87 participants (33 persons living with HIV, 54 without HIV). A directed content analysis was used to code responses into five levels of the SEM (individual, interpersonal, community, institutional, and structural). Results: Multiple themes emerged within each level: Individual – knowledge, fear, internalization; Interpersonal – social network; Community – judgements, discrimination, community organizations, norms; Institutional – competent providers, healthcare services; and Structural – systemic barriers, language, education. Conclusions: The findings exemplify the need for a multi-level approach to intervene and reduce HIV-related stigma. Based on the experiences and suggestions of people affected by HIV, future interventions should include substantial consideration from persons affected by HIV.