Introduction

Research on the lived experiences of HIV-positive men is essential for understanding the complex
interplay between health, social attitudes, and personal wellbeing. HIV remains a highly stigmatized
condition, and men living with HIV often face unique challenges related to disclosure, discrimination,
and mental health (Tran, Vu, Susa, & DeSilva, 2022). Stigma can lead to social isolation, emotional
distress, and barriers to accessing healthcare, which in turn affect treatment adherence and quality of
life (Liboro, Despres, Ranuschio, Bell, & Barnes, 2021) Furthermore, coping strategies and social
support networks play a critical role in mitigating these challenges, highlighting the need for research
that explores individual experiences in depth. Despite the growing body of literature on people living
with HIV, relatively few studies focus specifically on men and their unique psychosocial experiences
(Chakrapani, Kaur, Newman, Mittal, & Kumar, 2018). This literature review examines previous
research on HIV-positive men’s experiences, focusing on stigma, mental health, coping strategies,
relationships, and access to treatment, with the aim of identifying gaps and informing an Interpretative
Phenomenological Analysis study.
Stigma and discrimination
HIV-positive individuals face multifaceted challenges, particularly due to pervasive stigma and
discrimination from family, healthcare systems, and broader society (Yakasai & Ghani, 2021).These
societal reactions often stem from entrenched negative attitudes and misconceptions about HIV,
resulting in labelling, social exclusion, and systemic disadvantages (Kazuma-Matululu & Nyondo-
Mipando, 2021). Internalized stigma, or self-stigma, occurs when individuals living with HIV absorb
these negative societal perceptions, leading to psychological distress and adverse mental health
outcomes such as anxiety and depression (Ahmed, et al., 2022; Kooij, et al., 2021; Tristanto, Afrizal,
Setiawati, & Ramadani, 2022)
Stigma not only affects psychological wellbeing but also significantly hinders healthcare engagement
and adherence to antiretroviral therapy (ART) (Bhatta, Hecht, & Facente, 2021; Chepkemoi,
Nyikavarandaa , Semraub, Archera , & Pantelica , 2024; Wanjala, Nyongesa, Mapenzi, Luchters, &
Abubakar, 2023). Individuals experiencing stigma may be reluctant to seek treatment or disclose their
HIV status, reducing access to essential services and undermining public health efforts (Kanyemba,
Govender, & Jimu, 2021; Madiba, Ralebona, & Lowane, 2021). This process diminishes quality of
life, as stigma involves labelling, stereotyping, separation, status loss, and discrimination, all of which
compound social and psychological burdens (Chambers, et al., 2015)
Certain subgroups, such as adolescents or men who have sex with men, may face amplified stigma,
which further exacerbates mental health challenges and impedes treatment adherence (MacLean &
Wetherall, 2021; Rizzo, Calandi, Faranda, Rosano, & Vinci, 2024) . Non-adherence to ART can lead
to treatment failure, increased morbidity, and higher mortality rates ( Seunanden, Ngwenya, &
Seeley , 2025). Consequently, interventions addressing both biomedical and psychosocial aspects of
HIV are critical.
Recent research emphasizes resilience-building strategies to help individuals manage the
psychological impacts of stigma, fostering improved mental health outcomes and better engagement
with care (Brown, Martin, Knudsen, Gotham, & Garner, 2021). Understanding patients lived
experiences, including perceived barriers and satisfaction with treatment, is vital for improving
adherence and overall quality of life. (Ahad, Sanchez-Gonzalez , & Junquera, 2023; Kleinman, et al.,
2024).
Despite ART advances that have made HIV a manageable chronic condition, suboptimal adherence—
affected by stigma, social support, and other psychosocial factors—remains a challenge, particularly
for vulnerable populations ( Bauleth, Wyk, & Ashipala, 2016; Bukenya, Mayanja, Nakamanya,
Muhumuza , & Seeley , 2019; Sabin, et al., 2020).
This persistent challenge is largely attributed to the profound impact of HIV-related stigma, which
significantly compromises psychological processes necessary for consistent medication adherence
( France, et al., 2023). This pervasive stigma often results in heightened psychological distress, social
isolation, and a reluctance to disclose HIV status, further complicating adherence efforts ( Kip, Udedi,
Kulisewa, F. Go , & Gaynes , 2022).
Such distress is a common psychological problem for individuals living with HIV, contributing to an
increased risk of psychiatric issues and negatively impacting their overall well-being (Basha, Derseh,
Haile, & Tafere, 2019).
Overall, HIV-related stigma is a profound barrier to psychological wellbeing, treatment adherence,
and quality of life. Addressing this stigma through targeted interventions and psychosocial support is
essential for improving both individual and public health outcomes (Sayles, Ryan, Silver, Sarkisian ,
& Cunningham , 2007)
Mental Health and Coping Mechanisms
Studies consistently indicate that individuals living with HIV experience a significantly higher
prevalence of mental health disorders compared to the general population, with depression and
anxiety being particularly prominent (Leibowitz & Desmond , 2020; Ward, Puspitasari, Rose,
Gebremariyam, & Fauk , 2024).
This heightened vulnerability is often exacerbated by the multifaceted challenges associated with an
HIV diagnosis, including the enduring impact of social stigma and discrimination (Agyemang, et al.,
2022). The chronic nature of the illness, the demands of adherence to antiretroviral therapy (ART),
and the persistent threat of opportunistic infections further contribute to elevated stress levels and
psychological distress
Research highlights that over half of HIV-positive youth exhibit clinically significant mental health
symptoms, underscoring a critical need for targeted interventions within this demographic ( Machuka,
et al., 2020).
However, this susceptibility is not limited to young people; adults living with HIV also experience
considerable psychological burdens, often as a consequence of disease progression and societal
implications (Ward, Puspitasari, Rose, Gebremariyam, & Fauk , 2024). Global health crises, such as
the COVID-19 pandemic, have amplified these vulnerabilities, leading to worsening behavioural
health outcomes among people living with HIV (Brown, Martin, Knudsen, Gotham, & Garner, 2021).
The interplay between the biological effects of HIV, treatment demands, and psychosocial burdens—
including socioeconomic inequalities—further compounds the risk of mental health conditions,
particularly among adolescents and young adults ( Laurenzi, et al., 2020). HIV can also affect the
central nervous system, and combined with the psychological trauma of diagnosis, can precipitate
depression, mania, and cognitive impairments (Baingana, Thomas, & Comblain, 2005) . Prolonged
stress undermines immune function, highlighting the need for integrated care models that address both
physical and mental health.
Adolescents living with HIV/AIDS in sub-Saharan Africa are particularly vulnerable due to
widespread stigma, discrimination, and developmental challenges. Understanding these psychosocial
and emotional problems is critical for developing individualized management plans that consider
factors such as gender and mode of infection ( Adraro, Abeshu, & Abamecha, 2024). Despite global
efforts to control HIV, approximately 80% of adolescents living with HIV reside in Sub-Saharan
Africa, facing unique challenges that necessitate culturally sensitive and age-appropriate interventions
(Adejumo, Malee, Ryscavage, Hunter, & Taiwo, 2015)
Comprehensive mental health support, including counselling, peer support groups, and psychosocial
interventions, is essential to enhance coping, promote adherence to treatment, and improve quality of
life for HIV-positive individuals across all age groups.
Critical Gaps in Research
Despite significant advancements in HIV research, a critical gap remains in understanding the lived
experiences of men diagnosed with HIV (Ruiz, et al., 2022) .Much of the existing literature
generalizes findings to “people living with HIV” without disaggregating data to examine men’s
unique challenges and perspectives ( Misra, et al., 2021). This lack of specificity limits the
development of targeted interventions and obscures the complex interplay of gender, societal
expectations, and health outcomes in HIV care.
Qualitative research using methodologies such as Interpretative Phenomenological Analysis (IPA),
which can provide in-depth insights into personal narratives, is limited. Most studies rely on
quantitative surveys that often fail to capture the nuances of men’s day-to-day experiences (Coursey,
et al., 2023). Cultural differences further influence how men perceive and experience HIV, yet these
variations remain underexplored, constraining culturally sensitive support mechanisms ( Skovdal, et
al., 2011).
For instance, norms of masculinity in sub-Saharan Africa can profoundly affect men's engagement
with HIV care, acting as both barriers and facilitators depending on specific cultural contexts and
individual interpretations (Sileo, Fielding-Miller, Dworkin, & Fleming, 2019). Furthermore, men in
sub-Saharan Africa are less likely to engage in HIV services and more prone to AIDS-related
mortality compared to women, underscoring the urgent need for gender-specific approaches in
prevention and treatment (Wiginton, Mathur, Gottert, Pilgrim, & Pulerwitz, 2022).
This disparity is particularly stark in several sub-Saharan African countries, where men's engagement
with HIV care and treatment programs lags significantly behind that of women, often leading to
poorer health outcomes and higher rates of disease progression (Colvin, et al., 2020) . This trend is
particularly concerning given that men often present for care at a more advanced stage of the disease,
leading to higher morbidity and mortality rates (Kumar, et al., 2015; Quinn, Kadengye, Johnson,
Baggaley, & Dalal, 2019).
This disparity is often attributed to societal norms of masculinity, which may discourage men from
seeking healthcare services or openly discussing their health status, thereby impacting early diagnosis
and consistent engagement with treatment (Mantell, et al., 2019).
Despite these challenges, tailored interventions focusing on male-friendly services, health education,
and community-based approaches have shown promise in improving men's engagement in HIV care
(Dovel, et al., 2023).
Further research is needed to explore the specific barriers and facilitators to men's participation in
HIV services, particularly those related to logistical challenges like transportation costs and long wait
times (Coursey, et al., 2023). These factors collectively contribute to men's suboptimal engagement in
HIV programs, resulting in lower coverage of testing, prevention, and treatment services.
This gap is especially concerning as men tend to have lower rates of HIV testing, treatment initiation,
and viral suppression compared to women, highlighting the urgent need for tailored research (Quinn,
Kadengye, Johnson, Baggaley, & Dalal, 2019).
Addressing these gaps is essential to inform interventions that tackle barriers such as stigma,
healthcare access, and psychosocial support (Nardell, et al., 2022). Consequently, a significant
proportion of men remain unaware of their HIV status, further perpetuating the epidemic and
contributing to delayed diagnoses and treatment ( Fleming, Rosen, Wong, & Carrasco, 2019).
These systemic challenges necessitate a deeper qualitative investigation into the lived experiences of
men with HIV, particularly within high-burden regions, to uncover the nuanced factors influencing
their engagement with healthcare services and treatment adherence (Hlongwa, et al., 2022).
Conclusion
The reviewed literature highlights several recurring challenges faced by individuals living with HIV,
including pervasive stigma, mental health struggles such as depression and anxiety, and the adoption
of various coping strategies to navigate these difficulties. However, a critical gap persists in research
that specifically explores men’s lived experiences of HIV.
Most existing studies rely on quantitative surveys, which, while useful for identifying broad patterns,
often fail to capture the depth and complexity of personal narratives. This lack of qualitative inquiry,
particularly through methods such as Interpretative Phenomenological Analysis (IPA), has resulted in
limited understanding of how men uniquely experience and make sense of life with HIV. By
employing IPA, this study seeks to address this gap, amplifying the voices of HIV-positive men and
offering nuanced, culturally sensitive insights into their day-to-day realities. Such findings have the
potential to inform more effective, tailored interventions and support systems.

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