"Stigma's Every Day, All Day Long": A Qualitative Exploration of Experiences of Overlapping Stigmas and HIV Prevention Service Use Among Women Who Use Drugs.

In 2025, gendered inequities in HIV risk and harm remain for women who use drugs (WWUD). WWUD also have low levels of HIV prevention service engagement and likely experience intersectional stigma. The present study sought to explore WWUD's experiences with intersectional stigma and how those experiences shape HIV prevention service use to better inform the development of tailored intervention efforts. Individual in-depth interviews were conducted within the mHeaLth interventiOn To redUce Stigma study, a study to develop and pilot test an intervention to reduce intersectional stigma and improve HIV prevention service engagement among racially and ethnically diverse WWUD. Interviews elicited participants' experiences with stigma and perceived barriers and facilitators to HIV prevention services. Data were analyzed via thematic analysis. Intersectionality theory and the Health Stigma and Discrimination Framework were applied to emergent themes to conceptualize study findings. Narratives from 26 WWUD in San Diego County highlighted ubiquitous homelessness, drug use, misogyny, and/or other intersectional stigmas that were driven by structural-level factors (e.g., criminal justice environment, housing systems, local politics) and resulted in violence, health care avoidance, and receiving poor-quality care. Though most women reported not experiencing stigma within HIV prevention services, many still reported barriers to care (i.e., time, transportation, HIV stigma, shame/embarrassment, and lack of trustworthy information). Collectively, these findings highlight the pervasive nature of intersectional stigma in WWUD's lives, the detrimental impact that stigma has (i.e., violence and poor-quality care), and the need for flexible, mobile, and tailored HIV prevention interventions that target intersectional stigma.