Addressing stigma among persons living with HIV through the Sujaag project in Pakistan: A socioecological analysis

HIV-related stigma causes multifaceted problems for people with lived experiences. Stigma leads to feelings of shame and disgrace, and marginalizes persons living with HIV and their caregivers by marring social relationships and impacting health outcomes. In April 2019 Ratodero Tehsil in Larkana District, Pakistan, had an HIV outbreak, where evidence highlighted increase in infection rates among non-high-risk populations, including children. In the aftermath of this outbreak, affected families faced loss of communal ties in part due to stigmatizing attitudes. The Sujaag Project employed Participatory Action Research strategies to address HIV-based stigma and enhance acceptance of people living with HIV in the region. By utilizing a qualitative methodology, this study reports manifestations in changes in HIV stigma at four layers of the Socioecological Model: Individual, Interpersonal, Community and Social, and Macro levels. Findings from focus group discussions and reflective narrative reports gathered at varied points of the project cycle create an understanding of how HIV-related stigma affects wellbeing and how a collaborative and participatory approach aids in re-establishment of social relationships. This study informs contextual methodologies for incorporating lived experiences of HIV in program design, service delivery, and policy influence, and can be adapted for other stigmatized illnesses in similar contexts.