Cultural Norms and Acculturation Influences on HIV Perceptions and Stigma: A Qualitative Study of Black Migrants from sub-Saharan Africa Living with HIV in Australia

Black migrants from sub-Saharan Africa (SSA) living in Australia experience HIV-related stigma and delayed diagnosis. Despite biomedical advances, HIV continues to be interpreted through cultural, moral, and spiritual discourses that influence perceptions and care-seeking behaviour. This study explores how cultural norms and acculturation experiences shape HIV perceptions and stigma among black migrants from SSA living with HIV in Australia. Semi-structured interviews were conducted with 14 black migrants from SSA living with HIV between July 2024 and February 2025. Data were analysed thematically, supported by iterative categorisation, and informed by three theoretical frameworks: acculturation theory, stigma, and modified social-ecological model. Three interconnected themes emerged: (1) HIV misconceptions and misinformation persisted, with fear-based education reinforcing stigma; (2) HIV perceptions were linked to cultural norms, with HIV regarded as a taboo topic, attributed to immoral behaviour or spiritual causes, and blamed disproportionately on women; and [3] acculturation and shifting of HIV perceptions among black migrants from SSA living with HIV involved tension between cultural stigma and systemic marginalisation within Australia's HIV response, including exclusion from campaigns focused on gay and bisexual men (GBM). The findings illustrate that HIV-related stigma among black migrants from SSA living with HIV is shaped by cultural beliefs that persist after migration and continue to be reinforced within the host society through structural inequalities. Cultural norms and acculturation dynamics profoundly influence HIV-related stigma, perceptions of HIV, and engagement with care among black migrants from SSA living with HIV in Australia. The findings underscore the need for culturally responsive, community-informed interventions that bridge cultural beliefs and biomedical understandings, build trust in the health system, and ensure equitable representation in Australia's HIV response.