Stigma layers and resilience among people living with HIV from Romania

HIV is a chronic condition, but stigma is still a challenge for people living with HIV (PLHIV), UNAIDS calling for ”zero stigma and discrimination” by 2015. In Romania the majority of registered PLHIV were... [ view full abstract ]

HIV is a chronic condition, but stigma is still a challenge for people living with HIV (PLHIV), UNAIDS calling for ”zero stigma and discrimination” by 2015. In Romania the majority of registered PLHIV were nosocomially-infected between 1988-1990, followed by adults sexually infected, and an emerging group of injecting drug users (IDU). The objective of the present study was to investigate the layers of HIV stigma and the coping strategies PLHIV use to be resilient.
Thematic analysis was performed based on 20 in-depth interviews with PLHIV from three groups: (G1) those from the generation ‘88-’90, (G2) PLHIV infected as adults and (G3) the new group of HIV+IDU.
All three groups experience stigma, though differently. In G1 a ”charitable stigma” was experienced more severely in the early years of the infection, more by the family and less by the children (now young adults). In G2 stigma is driven by moral judgments (”moral stigma”), PLHIV being blamed for their behavior (same sex relationships or outside marriage). For G3 stigma appears to be associated with HIV but also with drug use or other addictive behaviors (e.g. alcoholism), sometimes even from other PLHIV (e.g. from G1 and G2) or from healthcare staff (”in-group and out-group stigma”). The resilient ones are those managing better their stigma (i.e. controlled disclosure), who have family support and are socially active in G1 and G2 while those overprotected by the family from G1 strive for normality (wish to have a family, children, a job). In G3 family, peers and religious beliefs act as resilience factors. Qualitative social work research captures the intricate layers of HIV stigma, successfully identifying what are the triggers for resilience while also providing evidence for social work practice and policy to adjust interventions; moreover, it advances theoretical understanding of HIV stigma in a changing social environment.