Intersectional Stigma Among Older People with HIV and COPD in Alabama: A Qualitative Study of Three Cases

Abstract

Introduction

Approximately 10–23% of people living with HIV (PLWH) experience chronic obstructive pulmonary disease (COPD) due to increased life expectancy. HIV- and COPD-related stigma have been studied, respectively, showing detrimental effects on health outcomes. Despite the number of PLWH with COPD and the potential negative synergistic effect of having both conditions, the intersectional stigma of HIV and COPD remains largely unexplored. Therefore, this qualitative study aimed to explore experiences related to intersectional stigma in older PLWH with COPD.

Methods

We recruited three PLWH with COPD aged 50 years or older from an HIV clinic in Alabama. The sample size was determined according to the purpose of the study to understand the depth of the phenomenon, rather than its breadth, using the qualitative approach. We conducted in-depth interviews and thematic analysis following an inductive coding process.

Results

Three major themes emerged: 1) stigma of HIV and stigma of COPD exist, 2) HIV stigma outweighs COPD stigma, and 3) the centrality of ignorance in HIV and COPD stigmas. When participants were questioned separately about HIV and COPD stigmas, they expressed stigma towards HIV due to misconceptions about the disease and towards COPD due to a smoking history, symptoms, and conspicuous treatment equipment. However, when participants were asked about both stigmas comprehensively, they described a more substantial stigma of HIV, causing it to eclipse that of COPD. In sharing their lived experiences, participants identified a lack of knowledge as the main factor contributing to stigmas related to both diseases.

Discussion

Understanding the stigma of older PLWH with COPD may improve how we help patients navigate disease-related stigma. Future research, interventions, and healthcare policies should focus on the pivotal role of education in reducing stigmas related to HIV and COPD.

Keywords:

• stigma
• HIV
• COPD
• intersectionality
• education

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

Dr Anand Iyer reports grants from NIH, personal fees from AstraZeneca, personal fees from Ascension, during the conduct of the study. Dr David Batey reports grants from National Institute of Mental Health (NIMH), National Institute of Nursing Research, National Institute of Allergy and Infectious Diseases, National Institute on Alcohol Abuse and Alcoholism and Centers for Disease Control and Prevention, outside the submitted work. The authors report no other conflicts of interest in this work.