People Living with HIV Stigma Index 2.0 in the Democratic Republic of the Congo

Abstract

The Democratic Republic of Congo (DRC), with an HIV prevalence estimated at 1%, faces strong stigma against people living with HIV (PLHIV), particularly among key populations (MSM, transgender people, sex workers, and people who inject drugs). The study aimed to document these experiences and their impact on access to care. A national cross-sectional survey was conducted in 2025 among 1,150 PLHIV across five provinces, combining electronic questionnaires and qualitative interviews. Data were collected using the Stigma Index 2.0 and statistically analyzed with STATA, R, and JAMOVI. The median age of participants was 35 years, with notable gender diversity (12.1% transgender). Socio-economically, 37.8% were unemployed and 80% lacked resources to meet basic needs. Disclosure of HIV status remained limited (52.6%) and often negatively experienced. External stigma manifested through social exclusion (18%), religious exclusion (12%), verbal abuse (50%), and non-consensual disclosure (48.6%). Internalized stigma was marked by shame (56.2%), guilt (54.8%), isolation (42.4%), and withdrawal from employment (58.4%). Medically, 96% were on ART, but only half were certain of viral suppression, and 20.9% had not had a recent viral load test. The most frequent comorbidities were non-communicable diseases (62%), sexually transmitted infections (53%), and tuberculosis (34%). The study shows that stigma, both external and internalized, remains a major barrier to health and social integration of PLHIV in the DRC. It calls for strengthening early testing, community awareness, protection of key populations’ rights, psychosocial support, and reduction of educational and economic inequalities.