Associations Between Stigma, Discrimination, and HIV Continuum of Care Outcomes Among Criminal Legal-Involved Youth...

Criminal legal-involved youth and young adults with HIV (CLI YWH) face considerable barriers to HIV care post-release. This secondary data analysis examined the relationship between three dimensions of stigma (e.g., internalized HIV stigma, healthcare discrimination, and intersectional stigma) and HIV continuum of care (HCC) outcomes (i.e., retention in care, medication adherence, and viral suppression) among CLI YWH enrolled in a multi-site clinical trial.

Generalized linear and logistic regression models were used to analyze associations between participant demographics and HCC outcomes with reported stigma and discrimination experiences at baseline.

Transgender women reported significantly higher levels of internalized HIV stigma (β = 0.24, 95% CI: 1.09-11.38, p = 0.02) compared to cisgender men. Participants with a high school education or more had greater odds of reporting intersectional stigma (OR = 3.25, 95% CI: 1.39-7.59, p < 0.01), suggesting that educational attainment may increase awareness of stigma rather than mitigate its effects. Perceived experiences of healthcare discrimination were more prevalent among transgender women (OR = 3.92, 95% CI: 1.32-11.60, p = 0.01) and were positively associated with higher provider-patient engagement (OR = 1.16, 95% CI: 1.05-1.28, p < 0.01).

These findings highlight an elevated burden of internalized HIV stigma and health care discrimination among transgender women and challenge the assumption that education uniformly protects against stigma. Instead, individuals with higher educational attainment may be more attuned to experiences of intersectional stigma. The positive association between healthcare discrimination and provider-patient engagement suggests a complex dynamic where experiences of stigma may also reflect or foster resilience and agency in navigating care. These results emphasize the need for cross-sector collaborations and inclusive, stigma-reducing strategies and affirming care models in healthcare settings responsive to the experiences of CLI YWH.