Perception and experience of HIV-induced stigma among people with HIV seeking healthcare in Ghana

Advances in health and technology have reduced HIV to a more manageable communicable disease. Yet, stigma and discrimination against people with HIV remain critical barriers to ending the pandemic by 2030. Due to limited literature on stigma and discrimination in Ghana, we aimed to assess the experiences and predictors of stigma among PWH seeking healthcare in selected health facilities. This convergent parallel mixed-methods study involved 420 people with HIV responding to a quantitative survey and 25 PWH participating in qualitative interviews (9 in-depth interviews and 16 in focus group discussions). Respondents were recruited through systematic and purposive sampling techniques for the quantitative and qualitative aspects, respectively. Quantitative data were analyzed using Stata/SE version 16.0, with logistic regression models fitted to measure associations between predictor variables and experienced stigma. Qualitative data were analyzed thematically using NVivo software, employing an inductive approach. Of the 420 participants, 58 (13.8%) reported ever experiencing stigma due to their HIV status. Among those who experienced stigma, 44 (75.9%) reported stigma in their communities, 24 (41.4%) in their homes, 15 (25.9%) at their workplaces, and 13 (22.4%) at health facilities. The most common forms of stigma were being gossiped about (26.0%), verbal insults/harassment (15.2%), and physical assault (8.3%). Qualitative findings corroborated these experiences, revealing impacts on healthcare access, social relationships, and mental health. Females (aOR = 13.10, 95% CI: 1.64-104.55) and persons with TB-HIV co-infection (aOR = 20.53, 95% CI: 3.28-128.56) had greater odds of experiencing stigma. PWH who were self-employed had lower odds of experiencing stigma at the HIV clinic (aOR = 0.07, 95% CI: 0.01-0.53, p = 0.009). Experienced stigma ranged from low to moderate in different settings, with communities being the most common location. We observed differences in stigma experienced among PWH based on gender, employment status, and TB co-infection. These findings suggest a need for targeted, context-specific interventions to reduce HIV-related stigma in Ghana, with a particular focus on community-level interventions.