Internal Stigma and Self-Directed Discriminatory Behaviours Among Key Populations in Malaysia: An Analysis from the Integrated Biological and Behavioural Surveillance (IBBS) Survey 2022

Internal human immunodeficiency virus (HIV) stigma poses a hindrance to the preventions of new HIV infections and individuals’ engagement in HIV treatment, care, and support programmes. The objective of this study was to assess internal stigma and self-directed discriminatory behaviours among key populations in Malaysia. A respondent-driven sampling (RDS) method was used to conduct the Integrated Biological and Behavioural Surveillance (IBBS) survey between July and December 2022 among four main key populations including men who have sex with men (MSM), transgender women (TGW), female sex workers (FSW), and people who inject drugs (PWID). Respondents’ internal stigma and self-directed discriminatory behaviours were measured using a fifteen-item in a validated self-administered questionnaire. The findings of this study showed that all key populations generally experienced low levels of internal stigma as they felt ashamed (21.4%), guilty (18.1%), blamed self (18.0%), and have low self-esteem (12.3%). Interestingly, majority (67.5%) reported zero internal stigma. In this study, only a quarter of respondents reported self-directed discriminatory behaviours as a result of internal stigma. This study suggested that internal stigma did not significantly lead to self-directed discriminatory behaviours among the respondents. However, understanding and addressing internal stigma are critical components of comprehensive HIV prevention, care, and treatment efforts.