Understanding the roots of patient–provider misalignment in perceived stigma in HIV care among Black American people living with HIV: insights from a qualitative study

Although healthcare providers have made efforts to reduce HIV-related stigma, people living with HIV (PLWH) still report stigmatizing experiences. Guided by Goffman’s stigma theory, Communication Accommodation Theory (CAT), and Link and Phelan’s framework of structural stigma, this qualitative study examines how stigma persists in HIV care through misalignment between providers’ intentions and patients’ perceptions and the roots of these misalignments. We conducted interviews with 11 PLWH and five providers. Inductive thematic analysis revealed that stigma was co-constructed across three levels. Interpersonally, patients experienced stigma as enacted through communicative cues, while providers often understood stigma as a structural problem. Communicatively, stigma emerged from mismatches between providers’ professional communication and patients’ expectations of empathy and relational engagement. Structurally, providers emphasized system-level barriers, while patients experienced institutional constraints as interpersonal exclusion. These findings suggest that HIV-related stigma in healthcare is sustained not only by explicit bias but also by misaligned communication within structurally constrained care settings.