{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T05:53:02Z","timestamp":1792821182405,"version":"4.5.0"},"reference-count":69,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["K01MH130226"],"award-info":[{"award-number":["K01MH130226"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000025","name":"National Institute of Mental Health","doi-asserted-by":"publisher","award":["R34MH130232"],"award-info":[{"award-number":["R34MH130232"]}],"id":[{"id":"10.13039\/100000025","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000118","name":"Office of Behavioral and Social Sciences Research","doi-asserted-by":"publisher","award":["D43TW009340"],"award-info":[{"award-number":["D43TW009340"]}],"id":[{"id":"10.13039\/100000118","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000061","name":"Fogarty International Center","doi-asserted-by":"publisher","award":["D43TW009340"],"award-info":[{"award-number":["D43TW009340"]}],"id":[{"id":"10.13039\/100000061","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Int Assoc Provid AIDS Care"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Human immunodeficiency virus (HIV) stigma has detrimental impacts on HIV care outcomes, mental health, and psychosocial well-being. Adolescents living with HIV (ALWH) in Malawi experience HIV stigma as gossip, insults, and physical distancing, contributing to decreased HIV care engagement and mental health issues including depression, substance use disorders, and suicidality. To inform future stigma-reduction interventions for this vulnerable population, we investigate how HIV stigma impacts an ALWH's ability to meaningfully participate in their social roles and responsibilities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This qualitative study recruited 68 participants from three government healthcare facilities in Lilongwe, Malawi. Our study sample consisted of 13 ALWH aged 13\u201319 years who screened positive for depressive symptoms on the Beck Depression Inventory-II with a score \u226513 (5 females, 8 males) and 55 stakeholders aged 13\u201354 years (38 females, 17 males). Guided by the What Matters Most Framework, we conducted 13 in-depth interviews and 10 focus group discussions with ALWH, adolescent peers without HIV, caregivers, teachers, HIV care providers, and mental health providers to examine culturally relevant manifestations of HIV stigma and its impact on ALWH's ability to fulfill socially expected roles. We organized data into four life domains\u2013home, community, school, healthcare\u2014which we analyzed to understand how stigma hinders social role performance, to assess how role fulfillment shapes stigma, and to identify strategies to reduce stigma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>ALWH identified their most salient social roles as being a family member, church member, student, friend, and active participant in one's healthcare. In each life domain, HIV stigma negatively impacted an ALWH's ability to meaningfully engage in their prescribed roles, resulting in ostracization from family and friends, displacement from one's home or school, disengagement from church, poor school performance and attendance, and reduced retention in HIV care. Key recommendations from study participants included engagement and collaboration with caregivers, increasing counseling services for ALWH with peer support, promoting community awareness and education, and redress systems for acts of stigmatization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study revealed that HIV stigma disrupts an ALWH's ability to fulfill key social roles in home, community, school, and healthcare settings. Stigmatization from caregivers within the home has the most detrimental impact on ALWH, identifying caregivers as critical part of stigma-reduction efforts. To effectively address stigma across all life domains, targeted stigma-reduction is needed, particularly through specialized counseling that addresses the unique aspects of ALWH personhood, and community education to disseminate accurate knowledge.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/23259582251413319","type":"journal-article","created":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T14:02:52Z","timestamp":1769608972000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Barriers to Belonging: How Stigma Disrupts Social Roles for Malawian Adolescents Living with HIV and Opportunities for Change"],"prefix":"10.1177","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-9959-6039","authenticated-orcid":false,"given":"Maria F.","family":"Faidas","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley N.","family":"Gaynes","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-9764-1229","authenticated-orcid":false,"given":"Laika","family":"Maganga","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Mphonda","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"Matewere","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeromy","family":"Nyirenda","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jack","family":"Kramer","sequence":"additional","affiliation":[{"name":"University of North Carolina Project-Malawi"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kazione","family":"Kulisewa","sequence":"additional","affiliation":[{"name":"Kamuzu University of Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nivedita L.","family":"Bhushan","sequence":"additional","affiliation":[{"name":"Research Triangle Park"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian W.","family":"Pence","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa A.","family":"Stockton","sequence":"additional","affiliation":[{"name":"University of Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,28]]},"reference":[{"key":"e_1_3_3_2_2","first-page":"11","article-title":"Key populations and Sub-Saharan Africa\u2019s HIV response","author":"Moyo E","year":"2023","unstructured":"Moyo E, Moyo P, Murewanhema G, Mhango M, Chitungo I, Dzinamarira T. Key populations and Sub-Saharan Africa\u2019s HIV response. Front Public Health. 2023;11.","journal-title":"Front Public Health"},{"key":"e_1_3_3_3_2","unstructured":"UNAIDS. The urgency of now: AIDS at a crossroads. 2024. https:\/\/www.unaids.org\/en\/resources\/documents\/2024\/global-aids-update-2024."},{"key":"e_1_3_3_4_2","unstructured":"UNAIDS. Country Factsheets Malawi. HIV and AIDS Estimates. 2023. https:\/\/www.unaids.org\/en\/regionscountries\/countries\/malawi."},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1186\/s44263-024-00072-3"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12887-022-03292-4"},{"key":"e_1_3_3_7_2","volume-title":"Stigma: Notes on the Management of Spoiled Identity","author":"Goffman E","year":"1963","unstructured":"Goffman E. Stigma: Notes on the Management of Spoiled Identity. Penguin Books; 1963."},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2013.07.035"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp08X280092"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-019-1271-3"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1037\/sah0000404"},{"key":"e_1_3_3_12_2","unstructured":"Centers for Disease Control and Prevention. HIV Stigma. 2022; https:\/\/www.cdc.gov\/stophivtogether\/hiv-stigma\/index.html. Accessed 23 Oct 2024."},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1017\/gmh.2018.15"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-023-03981-w"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2021.38.69.27843"},{"key":"e_1_3_3_16_2","unstructured":"Perin J Villavicencio F Eilerts-Spinelli H Liu L. Causes of death in Africa in 2021. 2024; https:\/\/childmortality.org\/wp-content\/uploads\/2024\/10\/10-CACODE2024-CausesDeathAfrica2021.pdf."},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(02)00304-0"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-009-9593-3"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325957412463072"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2006.11.013"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2013.09.009"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/10497323211001361"},{"key":"e_1_3_3_23_2","volume-title":"Social Stigma in The Handbook of Social Psychology","author":"Crocker J","year":"1998","unstructured":"Crocker J, Major B, Steele C. Social Stigma in The Handbook of Social Psychology. 4th ed. Oxford University Press; 1998.","edition":"4"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.schbul.a007096"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1525\/9780520950511"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10461-020-03012-y"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-020-04676-6"},{"key":"e_1_3_3_28_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0265530"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-019-2046-2"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12981-020-00292-1"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.7448\/IAS.17.1.18965"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-015-0649-9"},{"key":"e_1_3_3_33_2","doi-asserted-by":"crossref","unstructured":"Dao TT Gaynes BN Pence BW et al. Friendship Bench Intervention to Address Depression and Improve HIV Care Engagement Among Adolescents Living with HIV in Malawi: Study Protocol for a Pilot Randomized Controlled Trial. medRxiv. 2024.","DOI":"10.1101\/2024.04.11.24305686"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0302666"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.19102"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-069870"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2021.114523"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732318821692"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1207\/s15327752jpa6703_13"},{"key":"e_1_3_3_42_2","volume-title":"Qualitative Study","author":"Tenny S","year":"2022","unstructured":"Tenny S, Brannan JM, Brannan GD. Qualitative Study. StatPearls Publishing, Treasure Island (FL); 2022."},{"key":"e_1_3_3_43_2","doi-asserted-by":"crossref","unstructured":"Kutcher S Chehil S. Appendix 2: Tool for Assessment of Suicide Risk (TASR). In: Suicide Risk Management: A Manual for Health Professionals. Blackwell Publishing; 2007:66\u201370.","DOI":"10.1002\/9780470750933"},{"key":"e_1_3_3_44_2","unstructured":"Kutcher S Chehil S. The Tool for Assessment of Suicide Risk for Adolescents (TASR-A): How to use the TASR - A. Sun Life Financial Chair in Adolescent Mental Health 2007; https:\/\/mentalhealthliteracy.org\/product\/tasr\/."},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2021.306274"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.4135\/9781526441867"},{"key":"e_1_3_3_47_2","volume-title":"Qualitative Data Analysis with NVivo","author":"Bazeley P","year":"2019","unstructured":"Bazeley P, Jackson K. Qualitative Data Analysis with NVivo. 3rd ed. Sage Publications; 2019, 63\u201397.","edition":"3"},{"key":"e_1_3_3_48_2","unstructured":"Nvivo Version 14 [computer program]: Lumivero; 2023."},{"key":"e_1_3_3_49_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-319-69909-7_3470-2"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02766777"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.11613\/BM.2012.031"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.2989\/16085906.2019.1637912"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0232359"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2020.1864749"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1080\/17441692.2020.1782964"},{"key":"e_1_3_3_56_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0070254"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2015.12.017"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2021.1902935"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.1080\/09540121.2013.806770"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1080\/17450128.2023.2280059"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-024-02751-6"},{"issue":"4","key":"e_1_3_3_62_2","article-title":"Project YES! youth engaging for success: a randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15-24 years) in Ndola, Zambia","volume":"15","author":"Denison JA","year":"2020","unstructured":"Denison JA, Burke VM, Miti S, et al. Project YES! youth engaging for success: a randomized controlled trial assessing the impact of a clinic-based peer mentoring program on viral suppression, adherence and internalized stigma among HIV-positive youth (15-24 years) in Ndola, Zambia. PLOS ONE. 2020;15(4):e0230703.","journal-title":"PLOS ONE"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-019-6447-4"},{"key":"e_1_3_3_64_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0217693"},{"key":"e_1_3_3_65_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10648-018-9457-3"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyy036"},{"key":"e_1_3_3_67_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-021-11331-5"},{"key":"e_1_3_3_68_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13063-022-06643-9"},{"key":"e_1_3_3_69_2","doi-asserted-by":"publisher","DOI":"10.1177\/2325958219900713"},{"key":"e_1_3_3_70_2","doi-asserted-by":"publisher","DOI":"10.1093\/her\/cyr012"}],"container-title":["Journal of the International Association of Providers of AIDS Care (JIAPAC)"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259582251413319","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/23259582251413319","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/23259582251413319","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:50:53Z","timestamp":1777503053000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/23259582251413319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":69,"alternative-id":["10.1177\/23259582251413319"],"URL":"https:\/\/doi.org\/10.1177\/23259582251413319","relation":{},"ISSN":["2325-9582","2325-9582"],"issn-type":[{"value":"2325-9582","type":"print"},{"value":"2325-9582","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"article-number":"23259582251413319"}}