Cultural formation and determinants of HIV stigma among a minority group in Southwest China

Deeply ingrained cultural beliefs shape how HIV is framed and stigmatized, particularly among rural minoritized communities such as the Yi-Nuosu of Liangshan, China. This parallel-convergent mixed-methods study investigated the sociocultural formation and determinants of HIV-related stigma among Yi-Nuosu minorities. We conducted qualitative interviews with 19 Yi-Nuosu participants to understand local beliefs about the HIV-illness course and perceptions of people living with HIV (PLWH). We then administered an online quantitative survey to Yi-Nuosu (n = 221) and Han-Chinese (majority group; n = 109) residents of Liangshan to examine the relationships between HIV etiology beliefs and HIV-related stigma. Qualitative results indicated that prevailing fear of “unclean blood” and its perceived threat to communal harmony and familial lineage perpetuated stigmatization and exclusion of PLWH. Quantitatively, endorsement of traditional spiritual explanations of HIV, attributions of HIV transmission to unhygienic practices and casual contact with PLWH were associated with higher levels of stigma towards PLWH for both groups. Collectively, these findings underscore the importance of HIV stigma-mitigation interventions that integrate biomedical and traditional belief frameworks that challenge fears of proximal engagement with PLWH and reify intra- and inter-familial support for PLWH – a core cultural value within Yi communities.