What shapes People Living With HIV's experiences of HIV stigma in Delaware?: A qualitative exploration of place and social position.

Objectives: To understand how place and social position shape experiences of HIV stigma among people living with HIV (PLWH) in Delaware. HIV stigma impedes the health and wellbeing of PLWH. Yet, HIV stigma is often studied through psychosocial perspectives without considering social-structural conditions. Recent theorists have hypothesized that place and social position, two key social-structural conditions, fundamentally shape PLWH's experiences of stigma. Due to residential segregation of racial/ethnic and lesbian, gay, bisexual, transgender, and queer (LGBTQ) populations, place and social position are often inextricably intertwined within the U.S. Methods: Qualitative interviews were conducted with 42 PLWH and 14 care providers in 2017. Interviews were conducted with English- and Spanish-speaking PLWH in all three counties in Delaware, including: Wilmington in New Castle County, Smyrna in Kent County, and Georgetown in Sussex County. Results: Results suggest that PLWH's experiences of HIV stigma are shaped by place and social position. Although HIV stigma is still prevalent across Delaware, participants reported that HIV stigma is more pronounced in Kent and Sussex counties and in rural areas. Latinx and Haitian PLWH are at greater risk of experiencing HIV stigma than other racial/ethnic groups, with participants identifying misinformation within Latinx and Haitian communities as a key driver of HIV stigma. HIV stigma is further compounded by medical mistrust in the Haitian community. In contrast, participants noted that LGBTQ PLWH in Sussex County are somewhat buffered from HIV stigma by the LGBTQ community, which is reported to be more knowledgeable about HIV and accepting of PLWH. Conclusions: Multi-level interventions that address social-structural conditions in addition to individual-level factors are recommended to best address HIV stigma in Delaware. Interventions should target drivers of stigma, such as lack of knowledge, and consider how place and social position uniquely shape PLWH's experiences of stigma.

Improvements in Correctional HIV Services: A Case Study in Delaware.

This article describes the experience and outcomes of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies HIV Services and Treatment Implementation in Corrections protocol in the state of Delaware. The protocol was designed to test the effectiveness of a change team model in improving HIV services in correctional settings. In Delaware, a team was created with representatives from correctional and community agencies to work on improving linkage to HIV care for individuals released from incarceration. The team made improvements in the entire HIV service continuum: linkage to HIV care, HIV education, and HIV testing. The experiences in Delaware and the findings from this study suggest that the use of a change team model is a viable method for making organizational change in correctional settings.