Abstract
Background: Over 25% of the 1.2 million people with HIV in the US face stigma and discrimination in healthcare yearly. Miami-Dade, FL, has over 30,074 PLWH as of 2026, with many experiencing substance abuse, violence, depression, and anxiety, known as the SAVA syndemic. This syndemic increases stigma and discrimination, which reduce healthcare engagement, leading to lower ART adherence, unsuppressed viral loads, poorer quality of life, and early death.
Objective: This thesis aims to explore PLWH's lived experiences using Thematic analysis guided by the SAVA Syndemic to understand how stigma and discrimination affect healthcare engagement and adherence.
Methods: From Fall 2025 to Winter 2026, 13 PLWH participated in semi-structured Zoom interviews in English or Spanish, lasting 23-60 minutes. Interviews were transcribed, translated if needed, and coded independently by two trained coders, reaching at least 80% agreement after resolving discrepancies.
Results: Most participants reported negative healthcare experiences at the provider and clinic levels, desiring interactions that are free of stigma and supportive. Three themes emerged: Multilevel Factors Shaping Care Engagement; Social Relationships and Coping Mechanisms; The Human Aspect of Healthcare.
Conclusions: The findings highlight the need for training healthcare staff to reduce stigma. Future efforts should involve PLWH in developing provider training, including modules on patient-first care and wrap-around services to support engagement and quality of life.