“ He accepted me the way I am … most people can’t ”: a qualitative analysis of HIV stigma experienced by HIV sero-different couples who desire to conceive along Lake Victoria, Kenya

Objective: Safer conception strategies to reduce HIV transmission to sero-different partners are underused. Studies suggest this may be due to HIV-related stigma. We conducted a qualitative study to examine how forms of HIV stigma may impact reproductive decisions and seeking safer conception services.Methods: In-depth interviews (IDIs) with 16 sero-different couples residing in Kisumu County, Kenya, explored HIV-related stigma surrounding pregnancy, where stigma comes from, and if stigma might impact couples seeking safer conception services. Deductive and inductive approaches and framework analysis were used to analyze data at individual and dyadic levels.Results: Couples reported anticipated and enacted HIV stigma from the community. Among couples, there was little evidence of internalized stigma, and most participants described partner support and acceptance. Enacted stigma from healthcare workers was also rare. Although not described as internalized stigma, most participants expressed fear of HIV transmission to children and partners.Conclusion: These findings provide insight into sources and types of stigma that sero-different couples experience while navigating reproduction and its effect on seeking safer conception services. Interventions that address stigma from the community may help couples overcome stigma experienced at that level.