Selective disclosure and different levels of support: strategies for managing intersectional stigma in HIV healthcare engagement

HIV-related stigma has a significant impact on healthcare engagement and disclosure practices among people living with HIV (PLWH). Although stigma's detrimental effects are documented, few studies explore how intersecting stigmas within clinical and social domains collectively shape these behaviors. In this U.S.-based study, qualitative methods are used to examine how intersectional stigma influences healthcare engagement and selective HIV status disclosure among Black PLWH. An integrated theoretical framework combining intersectionality, socio-ecological models, and health belief models guided us in conducting semi-structured interviews with 11 diverse participants to identify patterns in stigma experiences, selective disclosure decisions, and support strategies. Participants reported widespread stigma in healthcare settings, which led to mistrust, delays in care and cautious disclosures. Additionally, social stigma from peers, families, and communities exacerbated isolation and limited access to healthcare. A strategic, adaptive response that relies upon perceived emotional safety and social stigma is needed. As necessary buffers, multilevel social support, ranging from family acceptance and peer networks to community-based organizations. These findings emphasize the complex, multilayered nature of stigma and the need for culturally sensitive, multidimensional interventions that address stigma comprehensively and enhance supportive environments for PLWH.