Applying the Social Ecological Model to Explore HIV-Related Stigma in Florida: A Qualitative Study

The purpose of this study is to describe human immunodeficiency virus (HIV)-related stigma and strategies to reduce it in Florida within the context of the social ecological model (SEM). Qualitative surveys were distributed at community events, advisory meetings, and conferences via electronic and paper-based methods to persons living with and without HIV over an 8-month period in 2018. A directed content analysis was used to code the responses of 76 participants (33 persons living with HIV, 43 without HIV) into five levels of the SEM (individual, interpersonal, community, institutional, and structural). Within each level, multiple themes and subthemes emerged: individual-knowledge, fear, internalization; interpersonal-social network; community-judgments, discrimination, community organizations, norms; institutional-competent providers, health care services; and structural-systemic barriers, language, and education. The findings exemplify the need for a multilevel approach that incorporates the perspectives of people with and without HIV to reduce HIV-related stigma in Florida. Clinical Impact Statement This is one of the first studies, to our knowledge, to qualitatively describe HIV-related stigma and strategies to reduce HIV-related stigma using the social ecological model (SEM) in Florida. Including the perspectives of persons with and without HIV in Florida is highly relevant given that HIV morbidity rates in the state are among the highest in the country, new HIV cases have shown significant increases in the past year alone, and enacted HIV-related stigma is prevalent. The findings of this study could guide the development of a multicomponent stigma reduction intervention that encompasses each level of the SEM.