Experiences of stigma and discrimination among adults living with HIV in a low HIV-prevalence context: a qualitative analysis.

Little is known about how people living with HIV in low prevalence contexts face the challenges of stigma and discrimination. Low prevalence and rural communities are unique environments in which HIV-related stigma and discrimination may be intensified due to lower tolerance of differences among people and greater fear of HIV. This study examined the experiences of 16 individuals living with HIV who reside in a predominantly rural area with low HIV prevalence. We used in-depth interviews to explore participants' experience with stigma and discrimination in social and health care settings and their behavioral and emotional responses. In their day-to-day lives, participants described feeling social rejection, being forced to follow different rules of social contact, and being treated differently. In health care settings, participants described specific instances when they felt providers were afraid of them and when they were refused or discouraged treatment or treated differently based on their HIV status. Participants experienced stigma and acts of discrimination in different settings (e.g., physician and dentist offices and hospitals) and from a range of types of providers (e.g., physicians, nurses, and dentists). Behavioral and emotional responses to perceived acts of stigma and discrimination included anger, shame, social isolation, and self-advocacy. Findings point to a need to develop tailored interventions to address stigma and discrimination for individuals, health care personnel and the community-at-large.