Understanding stigma as a barrier to cancer prevention and treatment: a qualitative study among people living with HIV in Uganda and Zambia

Objectives Extended life expectancy due to treatment improvements has increased the diagnosis of cancer among people living with HIV (PLWH) in Africa. Despite documented impacts of stigma on cancer preventive behaviours and care, little is known about the intersections of cancer and HIV stigma and the effects on prevention and care behaviours for both conditions. This study aims to examine experiences and drivers of cancer stigma and their associations with access to and utilisation of cancer prevention services among PLWH. Design This was a qualitative study consisting of eight focus group discussions with PLWH and 14 key informant interviews with HIV healthcare providers collected in January 2024. Setting Data were collected from two districts of Uganda and Zambia. In Uganda, the two selected districts were Arua, in the northern West Nile region, and Moroto, in the northeast Karamoja region. In Zambia, the study districts were Mongu, in the Western Province, and Chipata in the Eastern Province. Participants Each study district held two PLWH focus groups (one male, another female) with 5-7 participants per group and 3-4 key informant interviews for a total of 55 participants. PLWH and healthcare providers were eligible if they were (1) aged 18 years or older and (2) an HIV-positive client receiving antiretroviral therapy services at the participating clinic or working in a health services capacity at the clinic. Results Cancer stigma drivers included widespread misconceptions about disease origins and outcomes, associations with other stigmatising conditions and behaviours such as HIV, TB, and substance use, limited treatment options that heightened fears of diagnosis and inadequate training of healthcare providers. Study participants noted that experiences of stigma led to reduced treatment-seeking behaviours among PLWH, increased social isolation, and poor cancer-related care practices within clinics. Recommended interventions to combat stigma included improved education for providers and patients, private counselling, and peer support. Conclusions Results underscore the presence and impacts of stigma in the study population, emphasising the need for research informing culturally sensitive interventions that enhance educational outreach and promote engagement in care among targeted populations.