Evidence map›Paper›PMID 42432567›Full record

ArticleBMC public health2026

Visualizing stigma and HIV service engagement: a participatory approach using causal loop diagrams.

Meibin Chen, Stefan Baral, Sarah M Murray, Samuel M Jenness, Irah L Lucas, Travis Sanchez, Kaitlyn Atkins, Carrie Lyons, Yue Yu, Kristen Alicea-Jorgensen and 3 more

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Article in BMC 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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1 · What the graph read from it

What it found

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2 · The registry

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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

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3 · Its place in the literature

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No citing paper in PubMed yet.

4 · The record

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PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Meibin ChenDepartment of Civil and Systems Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA. mchen148@jhu.edu.
Stefan BaralDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Sarah M MurrayDepartment of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Samuel M JennessDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Irah L LucasDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Travis SanchezDepartment of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Kaitlyn AtkinsDepartment of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Carrie LyonsDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Yue YuDepartment of Civil and Systems Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.
Kristen Alicea-JorgensenDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Kalai C RobinsonDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
Takeru IgusaDepartment of Civil and Systems Engineering, Whiting School of Engineering, Johns Hopkins University, Baltimore, MD, 21218, USA.
Amrita RaoDepartment of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.

Funding

Integrating the Visualization and Use of Stigma Data to Maximize the Impact of the Ending the HIV Epidemic InitiativeR01MH132150 · NIMH · JOHNS HOPKINS UNIVERSITY · PI Stefan David Baral · 2022 to 2026
$5.1M
Characterizing the role of social, behavioral, and economic stigmas as determinants of HIV and mental health across the USR01NR020437 · NINR · JOHNS HOPKINS UNIVERSITY · PI BARAL, STEFAN DAVID · 2021 to 2025
$3.9M
The Johns Hopkins and Emory University AIDS Research Center – Center for HIV and Mental Health Stigma Elimination Strategies (CHIMES) P30MH136919 · NIMH · JOHNS HOPKINS UNIVERSITY · PI Stefan David Baral · 2024 to 2026
$2.9M
Program and implementation context of a housing support initiative to address homelessness and improve HIV service uptake among youth in the United StatesK01MD020002 · NIMHD · JOHNS HOPKINS UNIVERSITY · PI Amrita Rao · 2024 to 2026
$381k
NIMHD NIH HHS K01 MD020002NIMHD NIH HHS K01MD020002NIMH NIH HHS P30 MH136919NIMH NIH HHS P30MH136919NIMH NIH HHS R01 MH132150NIMH NIH HHS R01MH132150NINR NIH HHS 5R01NR020437-05NINR NIH HHS R01 NR020437
6 · The paper itself

Abstract

backgroundHIV stigma continues to undermine efforts to reduce HIV incidence and improve care outcomes in the United States, particularly among communities disproportionately impacted by the epidemic. While stigma is a known barrier to care, how it operates across HIV prevention, testing, and treatment remains difficult to characterize within complex service systems. This study employed a participatory systems science approach to map these dynamics across the HIV care continuum.

methodsWe conducted three virtual group model building sessions (10-15 participants per session) with stakeholders from city and state health departments and community-based organizations across Ending the HIV Epidemic priority jurisdictions to develop causal loop diagrams (CLDs). Literature-informed base diagrams for HIV prevention, testing, and treatment were iteratively expanded during facilitated discussions to identify key factors, causal relationships, and feedback loops. Diagrams were then refined and validated with academic experts; feedback loops were synthesized into core system domains and integrated into a comprehensive CLD.

resultsThe resulting CLDs highlighted interrelated feedback loops across three key domains: (1) personal health attitudes and care navigation, (2) provision of quality services, and (3) community influences on HIV-related health and care. Anticipated and internalized stigma were found to weaken social support and personal resilience, while enacted stigma from providers reduced care quality and compromised health data. Community-level stigma was described as highly context-dependent - reinforced by social isolation or reduced through visibility and inclusive norms in others. Overall, stigma was traced in pathways across individual, social, and structural subsystems.

conclusionsParticipatory systems methods can help visualize how socio-behavioral determinants, such as HIV stigma, dynamically shape engagement across HIV prevention, testing, and treatment. CLDs offer an intuitive framework for identifying leverage points for stigma mitigation, which can inform the design of multi-level interventions to support progress towards EHE goals.

trial registrationClinical trial number: not applicable.

Indexed as

HIV InfectionsSocial StigmaCommunity-Based Participatory ResearchHumansUnited StatesCausal loop diagramsHIV service engagementHIV servicesHIV stigmaParticipatory systems modelingSystems thinking

Identifiers

PMID42432567
PMCPMC13647785

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.