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The People Living with HIV Stigma Index in Central Texas Michelle Osorio, MPH & Rick Astray-Caneda III, PhD, MPA LGBTQ Quality of Life Advisory Commission | March 9, 2026 What is stigma? • Negative attitude or idea about a mental, physical, or social feature of a person or group of people that implies social disapproval • Stigma → attitudes and perceptions • Discrimination → actions and behaviors • HIV stigma is negative attitudes and beliefs about people with HIV • Can lead to discrimination, treating people with HIV differently than those without HIV • Affects people’s health and wellbeing, and discourages people from engaging in HIV testing, prevention, and care • Violates the human rights of people living with HIV 2 PLHIV Stigma Index in Central Texas • In-person, interview-based assessment to gather evidence on how stigma and discrimination impacts the lives of people living with HIV • Created by global networks of PLHIV with backing from UNAIDS and Johns Hopkins University • Standardized tool • Covers disclosure; experience of stigma and discrimination; internalized stigma and resilience; interactions with healthcare services; and human rights and affecting change • Questions added about housing, experiences with providers, and what can be done to stop stigma in our community • 100+ countries have completed the study, 100,000+ PLHIV have been interviewed Interviewers and participants (interviewees) are PLHIV • Interviewers receive $125, participants receive $100 Interview takes approximately 60-90 minutes Interviews offered in English and Spanish • • • 3 Methods: Phase 1 • Total sample size: 336* divided into two phases • Venue-based & referral-based sampling • Priority populations: • Gay men and other MSM • Sex workers • Transgender persons • People who use drugs • People experiencing homelessness • All gender identities and sexual orientations may participate • Main inclusion criteria: aware of HIV+ diagnosis for 12 months or longer & 18 years of age or older • Recruitment via social media campaign, strategic alliances with local ASOs, community partnerships, tabling events Number of PLHIV to be interviewed Bastrop Caldwell Hays Travis Williamson 10 10 10 60 12 Phase 1 Total 102 4 What will we learn? This study will guide us to have… Which will help us to address stigma by: • A clearer picture of HIV-related stigma and discrimination and its impacts • Detailed information by county • Detailed information by race, sex, ethnicity, and gender* • Informing development and implementation of FTC advocacy plan • Targeted interventions and programs (location, race, ethnicity, etc.) • Evidence to build empathy and drive advocacy, policy, programming • Engage PLHIV in services, networks of support • Advance equity across PLHIV • Enhance health outcomes for PLHIV *If sample size is reached We also are contributing to a global dataset with over 30,000 interviews – we are joining the fight against stigma! 5 Selected Survey Topics Participant characteristics • Sex & gender • Length of time since HIV diagnosis • Educational attainment Disclosure • People/groups of people who know about participant's HIV status Experiences of stigma and discrimination • • Exclusion from gatherings or activities (e.g., social, religious, family) Verbal harassment Internalized stigma • Effects of HIV status on self-confidence/self-respect, respect for others, stress- coping Effects of HIV status on relationships (ability to have secure relationships) • Interactions with healthcare services • • • Delaying/avoiding HIV test due to stigma HIV treatment status Delaying/avoiding treatment due to stigma/discrimination Human rights and affecting change • Abuses of rights (e.g., arrested, detained/quarantined, denied entry to another country, public disclosure, denied access to shelter) Stigma/discrimination experienced for reasons other than HIV status • Stigma due to sexual orientation - LGBTQ; questions disaggregated by each group • • • • • • • • • • • • • • Ability to meet basic needs in the last 12 months Minority group membership HIV support group membership Experiences disclosing status (e.g., reaction and supportiveness from people told) Refused employment or lost income Spouse/partner, children of participant have experienced discrimination Effects of HIV on personal/professional goals, community, and religion/faith Avoidance of social gatherings, healthcare, family/friends, jobs, due to status Interruptions/skipping/missing doses due to stigma, discrimination or other Other diagnoses (e.g., TB, mental health, substance use) and offered treatment Experiences of stigma/discrimination from healthcare providers (HIV and general) Advocacy by participant (e.g., educated people who discriminate, provide support to PLHIV, participated in organization or campaign, lobbied public figures, media awareness) Stigma for identifying as a sex worker Belonging to support group for LGBT people, sex workers, and people who use drugs 6 Your Health, Your Way ▪ Resource guide created by Fast-Track Cities, HIV Planning Council, and HIV Resources Administration ▪ Input from community members (including PLHIV) ▪ Information on peer support groups, mental health, HIV/STI testing, PrEP and HIV treatment, primary care, podcasts/media, + more! ▪ Provided to Stigma Index participants ▪ Available in English and Spanish ▪ Electronic and hard copies available ▪ Scan QR code below for PDFs of the resource guides 7 Progress: March 2026 ▪ 54+ of 102 interviews completed ▪ In-person recruiting at the David Powell Clinic ▪ Interviews conducted with residents of Travis, Williamson, Hays counties ▪ Stronger relationships with community stakeholders 8 How you can help ▪ Recruiting ▪ Interview space ▪ Sex workers ▪ Unhoused persons ▪ Trans persons ▪ PLHIV in neighboring counties (Bastrop, Caldwell, Hays) ▪ Spaces with ready access to ease scheduling ▪ Must be private ▪ Must have a table or desk and two chairs Later this year we’ll start community engagement to build a stigma action plan – we’ll be coming to you to help bring the right people to the table. 9 Thank you Please reach out with questions, comments, or feedback! Michelle Osorio, MPH Public Health Program Coordinator, Fast-Track Cities Michelle.Osorio@austintexas.gov Rick Astray-Caneda III, PhD, MPA Chair, Central Texas PLHIV Stigma Index Steering Committee rickyaciii@gmail.com Link to sign up for a Stigma Index interview: Stigma Index - Interest in Participating in an Interview / Índice de Estigma - Interés en participar en una entrevista 10