Abstract
HIV infection rates are increasing among marginalized women in Ontario, Canada. HIV-related stigma, a principal factor contributing to the global HIV epidemic, interacts with structural inequities such as racism, sexism, and homophobia. The study objective was to explore experiences of stigma and coping strategies among HIV-positive women in Ontario, Canada. We conducted a community-based qualitative investigation using focus groups to understand experiences of stigma and discrimination and coping methods among HIV-positive women from marginalized communities. We conducted 15 focus groups with HIV-positive women in five cities across Ontario, Canada. Data were analyzed using thematic analysis to enhance understanding of the lived experiences of diverse HIV-positive women. Focus group participants (n = 104; mean age = 38 years; 69% ethnic minority; 23% lesbian/bisexual; 22% transgender) described stigma/discrimination and coping across micro (intra/interpersonal), meso (social/community), and macro (organizational/political) realms. Participants across focus groups attributed experiences of stigma and discrimination to: HIV-related stigma, sexism and gender discrimination, racism, homophobia and transphobia, and involvement in sex work. Coping strategies included resilience (micro), social networks and support groups (meso), and challenging stigma (macro). HIV-positive women described interdependent and mutually constitutive relationships between marginalized social identities and inequities such as HIV-related stigma, sexism, racism, and homo/transphobia. These overlapping, multilevel forms of stigma and discrimination are representative of an intersectional model of stigma and discrimination. The present findings also suggest that micro, meso, and macro level factors simultaneously present barriers to health and well being--as well as opportunities for coping--in HIV-positive women's lives. Understanding the deleterious effects of stigma and discrimination on HIV risk, mental health, and access to care among HIV-positive women can inform health care provision, stigma reduction interventions, and public health policy.
Highlights
Mirroring global HIV statistics, HIV infection rates are increasing among women in Canada [1,2]
As of 2008, women constitute 22% of people living with HIV (PLHIV) within Canada and 26% of new HIV infections—an 11% increase from the previous year [1]
Stigma refers to processes of devaluing, labeling, and stereotyping that are manifested in the loss of status, unfair and unjust treatment, and social isolation of individuals or groups [9,10,11,12]
Summary
Mirroring global HIV statistics, HIV infection rates are increasing among women in Canada [1,2]. There is a 7-fold over-representation of new HIV infections in the Black female population in Canada in comparison with the general population This substantial health inequity underscores the necessity of understanding the factors driving the disproportionate impact of HIV among marginalized women in Canada. HIV-related stigma increases vulnerability to HIV infection by reducing access to HIV prevention and testing and presenting barriers to treatment, care, and support for PLHIV [3,4,5,6,7,8]. HIV-related stigma and discrimination— prejudice, negative attitudes, abuse, and maltreatment directed at people living with HIV—is a major factor contributing to the global HIV epidemic. HIV-related stigma, which devalues and stereotypes people living with HIV, increases vulnerability to HIV infection by reducing access to HIV prevention, testing, treatment, and support. Among HIV-positive people, those who have experienced HIV-related stigma have higher levels of mental and physical illness
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