SHINE Stigma Paper Data

Objective: Explore experiences of intersectional stigma among MWH and their partners who have unmet reproductive goals. Aim 1 - Conduct in-depth interviews with up to 30 MWH with unmet reproductive goals (no known partner pregnancy after 12 or more months of conception attempts) and a subset of 10 female partners to explore intersectional infertility and HIV-related stigma experiences (including dimensions of perceived community, anticipated, enacted, and internalized stigmas), pathways of sexual risk, and other barriers to HIV care and prevention for men and their partners. Hypothesis - Unmet reproductive goals and related intersectional stigmas are unrecognized drivers of poor HIV-related health outcomes among MWH and HIV incidence among women of reproductive age. We propose to evaluate how intersecting infertility and HIV stigmas at the provider, individual and community levels may contribute to HIV health and transmission risk behavior among men. Aim 2 - Estimate quantitative associations between infertility, intersectional stigma, HIV risk behavior, and engagement in HIV care among MWH. We will compare both self-report and objective measures of sexual risk behavior, HIV care engagement, and potential mediators/moderators including HIV and infertility stigmas among 100 MWH with and without unmet reproductive goals. Enroll (a) 50 MWH with recent unmet reproductive goals (no known partner pregnancy after 12 or more months of conception attempts) and (b) 50 MWH with partner pregnancy in the last year, all of whom want a child within in the next 2 years. Hypothesis - MWH with higher levels of infertility stigmas will have higher levels of sexual risk behavior and lower levels of HIV care/prevention engagement compared to MWH without infertility stigmas. Study Population Aim 1 - In-depth interviews were conducted with 30 men living with HIV and 10 female partners. All transcripts have been translated and transcribed and the qualitative analysis team has completed coding. Aim 2 – We screened and enrolled 50 MWH with met reproductive goals and 50 MWH with unmet reproductive goals have been enrolled. RA-administered questionnaire assessed demographics, reproductive history, partnership dynamics, HIV and infertility stigmas, sexual behavior, and structural factors shaping care engagement, partner HIV status, and disclosure (Table 1). Based on Aim 1 analysis, we added questions related to infertility and sexually transmitted infection history and partner STI history. The amendment was approved by MUST on 28/10/2022 and UAB on 21-11-2022. STI and fertility questions were asked to male participants only. If time allows in late March/early April 2023, all participants enrolled prior to the amendment approval, will be called by RAs to be asked questions telephonically. HIV- RNA testing (Aim 2): Enrolled participants were assessed for HIV-RNA (viral load) testing via GeneXpert HIV-RNA. STI testing (Aim 2): Enrolled participants were screened by NAAT testing (via GeneXpert) for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) and by blood sample for rapid immunochromatographic confirmed by rapid plasma reagent (RPR) to test for Treponema pallidum. All STI treatment regimens were accordance with standard Ugandan treatment and Standard of Care guidelines. (2026-08-20)