HIV Stigma Reduction Interventions in People Living with HIV in the United States: A Systematic Review.

HIV-related stigma remains a major barrier to improving health outcomes among people living with HIV (PLWH) in the United States, leading to reduced engagement in care, suboptimal adherence to antiretroviral therapy (ART), and diminished overall well-being. Stigma arises from misconceptions, societal rejection, and negative perceptions of HIV and manifests in multiple forms, including internalized, enacted, anticipated, and perceived stigma. Despite its well-documented impact, there is limited evidence on effective stigma reduction interventions in the U.S. This study conducted a systematic review to evaluate existing interventions and identify gaps in strategies to improve health outcomes for PLWH. Following PRISMA guidelines, four electronic databases (PsycINFO, MEDLINE, CINAHL Plus with Full Text, and Wiley Online Library) were searched for studies published between 2012 and 2025. Thirteen studies met inclusion criteria and were narratively synthesized. Interventions varied widely in design, including psychoeducation, peer support, mindfulness-based therapies, and multimedia tools, with durations ranging from one month to 12 months. Most studies focused on individual-level outcomes, particularly internalized stigma, and commonly measured outcomes included HIV-related stigma, ART adherence, and engagement in care. However, many studies had small sample sizes, lacked control groups, and had short follow-up periods. Only one study implemented a multi-site bundled intervention that included stigma reduction components. Notably, no studies addressed provider- or system-level stigma, and multilevel intervention approaches were absent. These findings highlight a critical gap in comprehensive stigma reduction strategies and underscore the need for future research targeting structural and provider-level stigma to improve health outcomes among PLWH.