ArticlePLOS global public health2026
The correlates and experiences of HIV-related intersectional stigma among caregivers of adolescents living with HIV during COVID-19 in KwaZulu-Natal, South Africa: Results from a mixed method study.
Article in PLOS global public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Caregivers play a critical role in promoting HIV adherence and positive mental health among adolescents living with HIV (ALHIV). However, the health and wellbeing of caregivers are often compromised by HIV-related stigma. Furthermore, in sub-Saharan Africa, the effects of HIV-related stigma are amplified by intersecting forms of stigma, such as poverty and gender. If we can identify the key drivers of HIV-related intersectional stigma, then we can develop targeted strategies to improve caregiver wellbeing. We used a mixed-method study design, utilising quantitative and qualitative baseline data from an economic incentive trial with n = 100 caregivers of ALHIV sampled from peri-urban clinics in Durban, KwaZulu-Natal, South Africa between November and December 2021. We drew on the trial's survey dataset that examined socio-demographics, mental health and wellbeing, and stigma. We conducted descriptive statistics and fitted a linear regression model to assess correlates of HIV-related intersectional stigma using STATA (V18). In-depth interview data (n = 16 caregivers) were analysed guided by the Health Stigma and Discrimination Framework in NVivo. Of the 100 caregivers in the analysis, 86% were female, with a median age of 43 years (IQR:34-50) and 75% living with HIV. Seventy-eight caregivers reported experiencing HIV-related intersectional stigma. More than half (52%) were experiencing depressive symptoms, 51% were living in severely food-insecure households, and 59% were experiencing a high caregiver burden. Caregiver burden and total direct cost of caregiving were correlated with HIV-related intersectional stigma. Key domains from the qualitative data suggest that HIV-related intersectional stigma increased caregiver burden, diminished psychological well-being, and was linked to the cost associated with caregiving. Results highlight the need for multi-sectoral HIV-related intersectional stigma programmes that focus on economic empowerment and mental health coping strategies to equip carers with the skills needed to manage HIV-related intersectional stigma.
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