For more than three decades, scientific advances have transformed HIV from a fatal diagnosis into a manageable chronic condition. Modern antiretroviral therapy can suppress the virus to undetectable levels, allowing people living with HIV to enjoy long and healthy lives. Yet despite this extraordinary progress, one persistent challenge continues to undermine treatment, wellbeing and public health efforts: stigma.
A new systematic review led by Chandni Shahdev from the Department of Public Health at the Zuckerberg College of Health Sciences, University of Massachusetts Lowell, reveals an interesting but troubling reality. While HIV stigma is widely recognised as a major barrier to care, remarkably little evidence exists on which interventions effectively reduce it in the United States.
Published in the journal AIDS and Behavior, the study, titled HIV Stigma Reduction Interventions in People Living with HIV in the United States: A Systematic Review, examined more than a decade of research to understand how stigma reduction programmes influence health outcomes among people living with HIV.
The findings suggest that although some interventions show promise, the scientific community still lacks robust evidence on how to tackle one of the most enduring obstacles in HIV care.
A problem hiding in plain sight
When most people think about HIV, they often focus on the virus itself. However, for many individuals living with HIV, the social consequences of diagnosis can be just as challenging as the medical condition.
HIV related stigma encompasses negative attitudes, discrimination, social rejection and harmful stereotypes directed towards people living with HIV. It can occur in communities, workplaces, healthcare settings and even within families. In many cases, people living with HIV internalise these negative perceptions, leading to feelings of shame, isolation and anxiety.
According to the review, stigma continues to affect medication adherence, retention in care, mental health and overall quality of life. Individuals who fear judgement or discrimination may avoid healthcare appointments, delay treatment initiation or choose not to disclose their HIV status, ultimately compromising their health outcomes.
Despite decades of public health campaigns and scientific progress, stigma remains deeply embedded within social structures and healthcare systems.
Scientists searched thousands of studies
The researchers conducted a comprehensive systematic review following internationally recognised PRISMA guidelines. Four major databases were searched for studies published between 2012 and 2025.
Initially, the search identified 3,529 records. After removing duplicates and applying strict eligibility criteria, only 13 studies met the requirements for inclusion.
This finding alone highlights an important gap in HIV research. Although thousands of publications discuss HIV stigma, very few studies have rigorously evaluated interventions designed to reduce it.
The review included a total of 2,141 participants living with HIV across the United States. Participants represented diverse backgrounds, including Black Americans, African immigrants, women living with HIV, newly diagnosed young people and members of sexual minority communities.
The small number of eligible studies suggests that while stigma is widely acknowledged as a public health challenge, evidence-based solutions remain scarce.
Why stigma affects more than emotions
Stigma is often perceived as a social or psychological issue, but its consequences extend far beyond emotional well-being.
The review found that HIV stigma can directly influence clinical outcomes. Internalised stigma, which occurs when individuals adopt negative societal beliefs about themselves, has been linked to lower adherence to antiretroviral therapy. Enacted stigma, involving direct experiences of discrimination, can discourage healthcare engagement and contribute to depression and anxiety.
Anticipated stigma, or fear of future discrimination, may lead people to avoid healthcare settings altogether. Perceived community stigma can foster social withdrawal, loneliness and reduced access to support networks. These effects can create a vicious cycle. Poor engagement in care can lead to poorer health outcomes, which may further reinforce feelings of isolation and vulnerability.
Some interventions show encouraging results
Although the overall evidence base remains limited, several interventions demonstrated positive outcomes. One of the most vital approaches involved peer led support programmes. The UNITY intervention, designed for African American women living with HIV, focused on discussions about stigma, discrimination and coping strategies. Participants experienced reductions in HIV related stigma, improvements in symptoms of post-traumatic stress disorder, and more consistent engagement with HIV care services.
Another successful programme, known as RISE, used culturally tailored counselling delivered by trained peer counsellors. Participants showed significant improvements in medication adherence over time compared with those receiving standard care.
Mindfulness based interventions also produced encouraging results. Programmes teaching meditation, self awareness and acceptance helped participants manage internalised stigma and improved adherence to HIV medication. Many participants reported feeling less burdened by the emotional weight of living with a stigmatised condition.
Multimedia approaches demonstrated potential as well. In one study, women living with HIV watched video stories featuring other women discussing their experiences with stigma. The intervention improved self-esteem, enhanced coping skills and reduced internalised stigma.
The missing piece in HIV stigma research
Perhaps the most important finding of the review was not what researchers found, but what they did not find. Nearly all identified interventions focused on helping individuals cope with stigma. Very few attempted to address the systems that produce stigma in the first place.
The review found no interventions specifically targeting healthcare provider stigma or broader healthcare system discrimination. Likewise, multilevel interventions addressing structural inequalities were largely absent. This represents a significant gap in current HIV research.
Healthcare-related stigma remains a major concern for many people living with HIV. Negative experiences with healthcare professionals can discourage future engagement in care and contribute to poorer health outcomes. Yet interventions designed to change provider attitudes, healthcare policies or institutional practices remain uncommon.
Beyond the Virus: How Reducing HIV Stigma Can Transform Lives.
—Chandni Shahdev
Vulnerable populations continue to face disproportionate burdens
The review also highlights the unequal distribution of HIV stigma across society. Many of the included studies focused on populations already facing multiple forms of discrimination, including Black women, African immigrants, sexual minorities and individuals experiencing housing instability.
Black women living with HIV emerged as a particularly important group. Previous research has shown that HIV related stigma often intersects with racism, sexism and socioeconomic disadvantage, creating complex barriers to care. African immigrants living with HIV may face additional cultural and social challenges, including concerns about community judgement and immigration related vulnerabilities.
The researchers argue that future interventions must better address these intersecting forms of discrimination. A one size fits all approach is unlikely to succeed when experiences of stigma vary considerably across different communities. Understanding how race, gender, sexuality, housing status and mental health interact with HIV related stigma will be essential for designing more effective interventions.
Reference
Shahdev, C., Rajabiun, S., Heavner, K., Wang, Y., & Cabral, H. (2026). HIV stigma reduction interventions in people living with HIV in the United States: A systematic review. AIDS and Behavior. https://doi.org/10.1007/s10461-026-05168-5
