Self-perceived stigma in people living with HIV in Spain: a mixed-methods study

Introduction: Despite medical advances, stigma against people living with HIV remains a major issue, especially in healthcare. Factors like ignorance and lack of training contribute to discrimination; studies show stigma varies by setting and provider background. This study in Spain aimed to explore self-perceived stigma and its impact on healthcare access. Methods: This mixed-methods study in Spain assessed self-perceived stigma among people living with HIV using a validated questionnaire and semi-structured interviews. Participants were recruited via social media and public announcements. Data analysis involved statistical tests and qualitative coding. Ethical approval was obtained, ensuring confidentiality and compliance with European regulations. Results: The study included 525 participants, mostly men (53.3%), with a median age of 38 years and an average of four years since diagnosis. The majority (96.2%) received care through the public healthcare system. Stigma levels varied; internalised stigma was low, with most rejecting negative feelings about living with HIV. However, anticipated and experienced stigma remained, particularly in healthcare settings, where many reported discrimination and neglect—findings corroborated in interviews. Avoiding physical contact with patients and the excessive use of barrier measures were common behaviours. Analysis showed that stigma decreases with age and time since diagnosis but is higher among non-binary individuals. Conclusions: This study highlighted varying levels of stigma affecting people living with HIV, particularly in healthcare. While internalised stigma was low, many anticipated or experienced discrimination, often due to impersonal treatment and unfounded fears, emphasising the need for education and awareness to foster respectful, empathetic care.