Nursing: Research and Reviews (Dec 2023)
Intersectional Stigma Among Older People with HIV and COPD in Alabama: A Qualitative Study of Three Cases
Abstract
Jun Y Byun,1 Crystal Chapman Lambert,1 Pariya L Fazeli,1 Anand S Iyer,1,2 David Scott Batey,3 David E Vance1 1School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA; 2Division of Pulmonary, Allergy, and Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA; 3School of Social Work, Tulane University, New Orleans, LA, USACorrespondence: Jun Y Byun, School of Nursing, University of Alabama at Birmingham, 1701 University Boulevard, Birmingham, AL, 35294-4410, USA, Tel +1 205 427 5878, Email [email protected]: 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
