Intersectional HIV Stigma Among Black Women: Regional Differences and Implications From the Black Women First Initiative.

Objectives. To explore intersectional stigma and sociodemographic characteristics, with consideration of US regional differences, among Black women with HIV enrolled in the Black Women First (BWF) initiative. Methods. In this prospective, nonrandomized study, participants' stigma scale responses and sociodemographic data were collected between May 2021 and August 2023. Participants participated in bundled interventions tailored to Black women's needs and local contexts during this time. Repeated measure models, adjusted for site clustering, were conducted with consideration of regional differences. Results. There were significant sociodemographic and baseline stigma differences between Black women residing in the US South and other regions. By the 12-month follow-up timepoint, because of bundled interventions, stigma significantly reduced among Black women, especially women in the South and transgender women. Conclusions. Bundled interventions with stigma-reduction approaches that address intersectional stigma and consider geography may be an effective way to reduce and eliminate stigma for Black women with HIV. Public Health Implications. BWF aligns with the National HIV/AIDS Strategy (2022-2025), promoting the development and expansion of culturally sensitive, evidence-informed interventions to improve Black women's health outcomes. (Am J Public Health. 2025;115(S1):S75-S84. https://doi.org/10.2105/AJPH.2025.308037).