Identity management in the face of HIV and intersecting stigmas

A metasynthesis of qualitative reports from sub-Saharan Africa

Bibliographic Data

ID19593859
AuthorsAmanda J Bergman (0000-0003-1474-7765, Johns Hopkins University, corresponding author), Alanna J Bergman, Katherine McNabb (0000-0003-0987-7952, Johns Hopkins University, corresponding author), Khaya Mlandu (corresponding author), Alvine Akumbom (0000-0002-6689-1104, Johns Hopkins University, corresponding author), Dalmacio D Flores (0000-0001-9202-7443, University of Pennsylvania, corresponding author)
EditorsJulia Robinson (0000-0003-0719-3995)
Year2023
Volume3
Issue2
Pagese0000706
Publication date2023-02-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0000706
PMID36962951
OpenAlexW4318765514
LanguageEN
Citations received6
References cited58

While stigma experienced by people living with HIV (PLWH) is well documented, intersectional stigma and additional stigmatized identities have not received similar attention. The purpose of this metasynthesis is to identify salient stigmatized intersections and their impact on health outcomes in PLWH in sub-Saharan Africa. Using Sandelowski and Barroso’s metasynthesis method, we searched four databases for peer-reviewed qualitative literature. Included studies (1) explored personal experiences with intersecting stigmas, (2) included ≥1 element of infectious disease stigma, and (3) were conducted in sub-Saharan Africa. Our multinational team extracted, aggregated, interpreted, and synthesized the findings. From 454 screened abstracts, the 34 studies included in this metasynthesis reported perspectives of at least 1258 participants (282 men, 557 women, and 109 unspecified gender) and key informants. From these studies, gender and HIV was the most salient stigmatized intersection, with HIV testing avoidance and HIV-status denial seemingly more common among men to preserve traditional masculine identity. HIV did not threaten female identity in the same way with women more willing to test for HIV, but at the risk of abandonment and withdrawal of financial support. To guard against status loss, men and women used performative behaviors to highlight positive qualities or minimize perceived negative attributes. These identity management practices ultimately shaped health behaviors and outcomes. From this metasynthesis, the Stigma Identity Framework was devised for framing identity and stigma management, focusing on role expectation and fulfillment. This framework illustrates how PLWH create, minimize, or emphasize other identity traits to safeguard against status loss and discrimination. Providers must acknowledge how stigmatization disrupts PLWH’s ability to fit into social schemas and tailor care to individuals’ unique intersecting identities. Economic security and safety should be considered in women’s HIV care, while highlighting antiretrovirals’ role in preserving strength and virility may improve care engagement among men

Aesthetics · Art · Political science · Qualitative research · Social science · Sociology · Adolescent Sexual and Reproductive Health · Anthropology · Gender Studies · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Virology