Quantifying HIV Stigma from the PLHIV Perspective: The Role of Involuntary Status Disclosure, Minority Identity, and External Support in Bali, Indonesia

Background: Given the public health implications of stigma in limiting access to essential services and affecting the well-being of people living with HIV (PLHIV), evidence from local contexts in Indonesia remains limited. This study addresses this gap by assessing the characteristics and exploring the factors associated with HIV stigma among PLHIV in Denpasar, the most populous area in Bali with the highest number of reported HIV cases. Design and Methods: A cross-sectional study was conducted in 2024 with 285 PLHIV from five health facilities in Denpasar. A 68-item questionnaire was used to assess the characteristics of enacted stigma (external discrimination) and internalized stigma (negative self-perception due to HIV status) experienced by PLHIV. Data were analyzed using chi-square tests for both outcomes; enacted stigma proceeded to multivariable logistic regression, while internalized stigma was excluded due to poor model fit. Results: Overall, 20% (n = 57) reported enacted stigma, while 93.7% (n = 267) experienced internalized stigma. External support was significantly associated with internalized stigma (p = 0.003). Regression analysis showed that involuntary status disclosure history (aOR = 5.692, 95% CI: 2.660-12.181) and minority identity (aOR = 3.393, 95% CI: 1.048-10.989) significantly influenced enacted stigma. Conclusions: These findings highlight the need for interventions to reduce stigma at individual, community, and structural levels. The intervention program should focus on increasing external support, confidentiality, and layered intervention, especially for minority PLHIV populations.