Worldwide changes in HIV-related stigma among people living with HIV: A cross-temporal meta-analysis and systematic review

BACKGROUND: HIV-related stigma among people living with HIV has emerged as a growing public health concern, yet limited longitudinal data are available to characterize its evolution over time. In this study, we employed a cross-temporal meta-analysis to systematically assess whether the level of HIV-related stigma has increased, utilizing standardized measurement tools to quantify potential changes. AIM: To systematically review the worldwide changes in HIV-related stigma among people living with HIV. DESIGN: Cross-temporal meta-analysis and systematic review. METHODS: We searched 10 databases (from their inception to August 2025) for studies that measured HIV-related stigma using the Berger HIV Stigma Scale (BHSS). Two researchers independently screened the studies and extracted data. Correlation, regression and quantitative analyses of differences in HIV-related stigma were conducted using SPSS 27.0.1 and R 4.5.0. RESULTS: A total of 104 studies involving 43ƒ_%678 samples were included in this study. The results showed that from 2004 to 2023, year was only positively associated with disclosure concerns, but this correlation was very weak (rƒ_%=ƒ_%0.272). However, weighted linear regression indicated mild increasing trends in total BHSS score, disclosure concerns and concern with public attitudes across years (Iýƒ_%=ƒ_%0.244-0.388). Subgroup analyses revealed variations in trends across different continents: Asia and Africa generally exhibited an upward trend, whereas North America and Europe showed an overall downward trend. Additionally, there were trending differences by gender, residential location and marital status: Female, rural and married people living with HIV showed a slight increasing trend in HIV-related stigma, but these differences were not statistically significant. Lagged analyses indicated no significant association between HIV-related stigma and three categories of social indicators (economic status, social support and health care). Notably, segmented linear regression was used to analyse the trend of HIV-related stigma before and after 2020. The results indicated a potentially stronger upward trend in HIV-related stigma after 2020 (Bƒ_%=ƒ_%-0.009 to 0.257) compared with the period prior to 2020 (Bƒ_%=ƒ_%-0.036 to 0.037). CONCLUSION: From 2004 to 2023, correlation analysis showed no significant association between overall HIV-related stigma and year, whereas weighted regression models indicated a mild increasing trend in HIV-related stigma, underscoring the urgent need for interventions. Furthermore, preliminary findings indicated a possible upward trend in HIV-related stigma around 2020. This tentative trend suggests that relevant stakeholders may consider prioritizing the monitoring of psychological status among individuals with inadequate psychosocial support during major public health events, with the aim of providing timely and targeted interventions as needed

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Income
  • Social support
  • Health services
  • Stigma/discrimination
• Population(s)
  • General HIV+ population
• Health Systems
  • Governance arrangements
  • Delivery arrangements