Stigma and Time: A Longitudinal Qualitative Analysis of Co-occurring HIV and Tuberculosis Stigma in South Africa

For people with HIV and tuberculosis (TB), stigma may change over time. Identifying time points when individuals are most likely to experience HIV or TB related stigma, or when stigma begins to abate, may be useful in tailoring stigma-reduction interventions in resource-limited settings. This study used longitudinal qualitative data to explore if and how HIV and TB stigma change over the course of treatment. People living with HIV and rifampicin-resistant TB were purposively recruited at a district TB hospital in KwaZulu-Natal, South Africa. Participants consented to in-depth interviews throughout TB treatment. The team used reflexive thematic analysis to develop latent themes within the transcripts. This study was designed to identify longitudinal changes stigma over time from the perspective of someone living with HIV and TB. However, participants were more expansive in their conceptualization of evolving stigma. 30 individuals discussed changes in stigma from three distinct perspectives. First was a perspective of lived experience, where participants described changes in experienced, internalized, and anticipated stigma over time beginning with diagnosis. The second was from a shifted perspective, as participants described their diagnosis and movement from status neutral to status positive transitioning from a potential enactor of stigma to someone at risk for experiencing stigma. Finally, participants described changes in stigma from the community perspective whose attitudes towards HIV and TB disease were shaped by time. To strengthen care engagement, we must effectively intervene on disease-related stigma. Appropriate interventions must consider time and shifting social expectations that impact stigma.