Constructed narratives of HIV stigma, coping and disclosure among HIV positive African Americans living in the South

Background: Despite increased prevention efforts, African Americans continue to be disproportionately affected by HIV/AIDS, especially in the Southern region of the US. HIV related stigma in this region, especially in rural areas, has contributed to the lack of utilization of HIV-related care and preventive services. Mid-sized Southern cities that serve surrounding rural counties are understudied regions impacted by HIV/AIDS. These cities are unique because they share the same barriers as both rural and large cities in providing HIV-related care. Methods: In order to investigate the influence of HIV stigma in these types of mid-sized cities and understand issues in providing effective services to this population, we used narrative analysis to examine stigma, coping and disclosure among HIV positive African Americans. Individual narratives from focus groups and in-depth interviews were constructed into one large narrative in order to share participant stories without the researchers' voice and to enrich the understanding of their experience. Results: Participants experienced rejection and blame from loved ones, loss of jobs and engaged in negative coping behaviors such as drugs, self-imposed isolation, multiple suicide attempts and depression. Positive coping behaviors were also adapted such as improved relationships with others, spiritual growth, and self-motivation. Conclusions: Better understanding the impact of stigma can help in tailoring services for HIV positive African Americans in the South and the development of interventions addressing stigma, which can ultimately help to reduce the spread of HIV in this region that has previously been neglected.