Managing collateral stigmatization while accessing biomedical HIV prevention for queer people in Dar es Salaam

This paper introduces the concept of collateral stigma to analyze how queer people in Dar es Salaam navigate HIV prevention through Pre-Exposure Prophylaxis (PrEP). Drawing on 11 months of ethnographic fieldwork (2021-2022), we show how PrEP use exposes individuals to unintended and misattributed stigmatization: being perceived as HIV-positive, queer, or a sex worker despite efforts to conceal these identities. Through case studies, we illustrate how stigma materializes in pills, spaces, and institutional practices, shaping strategies of concealment and avoidance. While PrEP aims to reduce HIV risk, fear of collateral stigma often deters uptake or leads to unsafe practices, paradoxically increasing vulnerability to HIV. We situate these findings within Goffman's notion of concealable stigma and extend it by considering structural power relations that produce stigma as a social process. The paper argues that collateral stigma complicates global health interventions by creating unpredictable barriers to care. We conclude by recommending stigma-sensitive programming, including discreet medication packaging and flexible service delivery, to ensure that HIV prevention does not require risking social exclusion. By conceptualizing collateral stigma, this study advances theoretical debates on stigma and offers practical insights for designing inclusive, stigma-free HIV prevention strategies.