An intersectional analysis of HIV stigma and healthcare access challenges among young people living with HIV in Karachi, Pakistan

HIV-related stigma remains a major barrier to healthcare access and well-being among young people living with HIV, particularly in low- and middle-income settings. In Pakistan, limited evidence exists on how stigma is experienced and negotiated by young people within complex sociocultural and structural contexts. This study aimed to explore the lived experiences of YPLHIV in Karachi, with a specific focus on how intersecting identities and social determinants shape experiences of stigma and access to healthcare. A qualitative phenomenological approach was employed to capture participants’ lived experiences. In-depth semi-structured interviews were conducted with twenty-five YPLHIV aged 19–30 years in Karachi using purposive sampling. Participants represented diverse gender identities, including transgender, non-binary, and cisgender individuals. Interviews were conducted in Urdu and English, audio-recorded with consent, transcribed verbatim, and translated into English. Data were analysed thematically using Thematic analysis informed by phenomenological principles and interpreted through HSDF and Intersectionality Theory. Data collection continued until thematic saturation was achieved. Seven key themes emerged. Age-related stigma positioned HIV as incompatible with youth, leading to moral judgment and barriers in education and care. Gender and sexuality norms shaped stigma, with women, transgender, and gender-diverse individuals experiencing compounded discrimination. Poverty and structural inequality limited access to care and increased exposure to stigma. Healthcare settings were identified as key sites of stigma, including breaches of confidentiality and discriminatory provider behaviours. Family and community norms contributed to fear of disclosure, while religious and moral narratives shaped both stigma and coping. Despite these challenges, participants demonstrated resilience through peer support, self-advocacy, and identity reconstruction beyond HIV. HIV-related stigma among YPLHIV in Karachi is intersectional and structurally embedded, shaped by social, cultural, and institutional factors. Addressing stigma requires multi-level interventions, including stigma-sensitive healthcare systems, youth-friendly services, strengthened confidentiality protections, and community engagement. An intersectional approach is essential to designing equitable, culturally responsive strategies that improve healthcare access and well-being for YPLHIV.