Evolving experiences of HIV stigma and their impact on well-being: A serial cross-sectional study of people living with HIV in Hong Kong from 2012 to 2022

The Undetectable = Untransmittable campaign has transformed HIV prevention over the past decade, potentially reshaping societal perceptions of people living with HIV (PLHIV). While this scientific breakthrough challenges traditional stigmatizing narratives about HIV transmission, there is a lack of empirical evidence on how different forms of HIV stigma have changed over time. The present study aimed to document changes in enacted, anticipated, and internalized stigma over a ten-year period and examine their associations with well-being among PLHIV. A serial cross-sectional study was conducted in Hong Kong, with 291 PLHIV completing a questionnaire in 2012–2013 and 236 PLHIV participating in 2020–2022. The results indicated that a significantly greater proportion of PLHIV disclosed their HIV status over time. The results also revealed significant changes in enacted stigma patterns, with a notable decrease in discrimination in healthcare settings but an increase in discrimination from friends. Levels of anticipated stigma, internalized stigma, and well-being remained unchanged between the two time points. Additionally, the results provide empirical support for the dual-process model of HIV stigma, demonstrating how both interpersonal and intrapersonal manifestations of stigma affect well-being. The study provides valuable insights into HIV care and support services, indicating that changes in enacted stigma alone may not be sufficient to enhance the well-being of PLHIV. It highlights the persistence of anticipated and internalized stigma even in the context of improved institutional environments, which underscores the need for more targeted psychological interventions for PLHIV. • A greater proportion of PLHIV disclosed their HIV status in various settings over time. • Enacted stigma in healthcare settings decreased but discrimination from friends increased. • Anticipated stigma, internalized stigma, and well-being remained unchanged over time. • The results provide evidence for the interpersonal and intrapersonal pathways through which HIV stigma affects well-being. • Enacted stigma had a direct impact on well-being, while the effect of anticipated stigma was mediated by internalized stigma.