Spatial Heterogeneity of Digital HIV/AIDS Stigma in China: Cross-Sectional Ecological Study

HIV/AIDS stigma remains a major barrier to public health intervention and social inclusion. In China, short-video platforms, such as Douyin, have become important spaces where people living with HIV/AIDS share daily-life narratives and receive public responses. However, little is known about how public responses to these narratives vary geographically, or how regional sociodemographic and epidemiological contexts are associated with digital stigma and support.

This study aimed to examine the thematic structure, spatial heterogeneity, and macro-level correlates of public responses to daily-life narratives shared by people living with HIV/AIDS on Douyin in China, with a focus on spatially varying correlational patterns of digital HIV/AIDS stigma.

We constructed a corpus of 174,394 public comments from Douyin videos created by people living with HIV/AIDS. DeepSeek R1 671B was used to classify comments into 9 substantive themes and 1 residual "others" category. Provincial topic indices were calculated by normalizing thematic comment counts by mobile internet access users. We then combined the least absolute shrinkage and selection operator feature selection, ordinary least squares, and spatial econometric models, residual spatial autocorrelation diagnostics, false discovery rate correction, and Shapley Additive Explanations (SHAP)-geographic information system (GIS) interpretation to examine global associations and localized variable contributions across 31 provincial-level units in mainland China.

Moral judgment and attribution of blame were the most prevalent substantive theme (41,663/174,394, 23.89%), followed by disease knowledge and transmission discussion (23,344/174,394, 13.39%), and support, encouragement, and humanitarian care (18,101/174,394, 10.38%). Spatial analysis showed pronounced geographic heterogeneity in both stigma- and support-oriented public responses. HIV incidence was positively associated with disease knowledge, social impact discussion, moral judgment, and support, while gender ratio was significantly associated with moral judgment and related evaluative themes. SHAP-GIS further revealed stronger positive contributions of HIV incidence to moralizing discourse in several southwestern provinces and a marked north-south pattern in the contribution of gender ratio.

Digital public responses to daily-life narratives shared by people living with HIV/AIDS in China are geographically uneven and associated with place-based sociodemographic and epidemiological contexts.