Divergent perceptions of HIV stigma in healthcare facilities: a multi-stakeholder study in Denpasar, Indonesia

HIV stigma in healthcare settings remains persistent, despite the implementation of various mitigation strategies. This study aimed to explore how HIV stigma is perceived and experienced from a multi-stakeholder perspective, including people living with HIV (PLHIV) in Denpasar City, Indonesia, in order to identify critical points for intervention. This study employed an exploratory qualitative approach, with data collected through in-depth interviews and focus-group discussions (FGDs). Participants included a range of HIV service stakeholders (healthcare workers, non-healthcare staff, NGOs, academics, and city-level HIV program managers) and PLHIV. Data were analyzed using thematic analysis. A total of 41 participants from diverse backgrounds were included in this study, comprising 19 healthcare workers, 8 non-healthcare staff, 4 NGO representatives, 8 PLHIV, 1 academic, and 1 city-level HIV program manager. The findings show that service providers perceived stigma as minimal due to the absence of explicit discrimination, whereas PLHIV, NGOs, and academic reported persistent enacted, anticipated, and structural stigma. The manifestations included nonverbal expressions of rejection, differential treatment, disclosure of HIV status without consent, discriminatory practices linked to healthcare standard operating procedures (SOPs), and fear of HIV status disclosure among PLHIV. Not all manifestations of HIV stigma reported by PLHIV and NGOs were recognized by healthcare providers as indicative of stigma. Persistent stigma in healthcare settings was linked to knowledge gaps, sociocultural influences, and institutional factors. This study highlights differences in perspectives between service providers and service recipients in interpreting HIV stigma, which should be carefully considered in the development of future interventions. In this context, more comprehensive interventions that go beyond technical skills are needed, including enhance sociocultural understanding, effective communication, and more patient-centered care approaches. Not applicable.