Mapping intersectional stigma and resilience sources across socio-ecological levels among people living with HIV: a qualitative study

Stigma remains a significant barrier to health care and well-being for people living with HIV (PLWH), especially when compounded by racial identity and sexual orientation. Most existing studies address stigma in isolation, overlooking its compounded effects. Guided by the socioecological model, intersectionality theory, and resilience theory, this qualitative study explored how intersectional stigma (perceived, internalized, enacted) related to HIV status, race/ethnicity, and sexual orientation. Semi-structured interviews were conducted with 11 PLWH from diverse backgrounds until thematic saturation was reached. Analysis identified intersecting stigma forms resulting in social rejection, anticipatory discrimination, and internalized shame. Resilience emerged across individual (self-advocacy), interpersonal (peer support), and community (solidarity) levels, mitigating emotional, social, and healthcare-related impacts. Family and community simultaneously served as sources of harm and resilience. Findings indicate the need for multilevel, culturally responsive interventions addressing structural and relational stigma while enhancing supportive networks to promote health care engagement among PLWH.