HIV-related stigma and self-management in young people living with HIV in rural South Africa: a socioecological perspective

Despite progress toward UNAIDS 95-95-95 targets, HIV-related stigma continues to undermine self-management and health outcomes, particularly in rural areas. This study explored how stigma influences self-management among young people living with HIV (YPLHIV) in rural South Africa, applying a socioecological model to examine individual, social, institutional, and structural factors shaping health behaviors and cognitive functioning. Twenty interviews were conducted with YPLHIV aged 18-35 years. Data were thematically analyzed. Participants described intense internalized stigma and fear following diagnosis, often leading to shame, isolation, or suicidal ideation. Counseling, health education, and treatment success promoted self-efficacy and acceptance, enabling adherence and future-oriented goals. Family and caregiver support fostered resilience, while peer rejection reinforced stigma. Positive relationships with healthcare providers encouraged adherence, though gaps in communication around viral load and CD4 monitoring were noted. At the structural level, supportive health policies, free antiretroviral treatment, and routine testing enabled early diagnosis and treatment, but poverty and unemployment limited the ability to maintain healthy lifestyles. HIV-related stigma profoundly shapes the psychosocial well-being and self-management behaviors of YPLHIV. Interventions that strengthen self-efficacy, mental health support, and coping strategies, while simultaneously addressing family, community, and structural contexts, are essential to reduce the stigma's impact and promote sustained engagement in care.