Intersectional Barriers Among PLHIV in Rural Illinois: Insights from a Pilot QCA Study.

People living with HIV (PLHIV) in under-resourced rural regions face intersecting social and structural barriers that intensify their vulnerability. This pilot study explored how overlapping marginalized identities and socioeconomic hardship shape experiences of discrimination among PLHIV in Southern Illinois. Twenty-two participants completed a community-informed survey that captured racial, sexual, and gender identities alongside indicators of stigma across healthcare, housing, employment, and community settings. The findings reveal that most participants experienced at least one form of discrimination, with the highest burden concentrated among those identifying as Black, Nonbinary, Gay/Lesbian, or low-income. Discrimination was particularly prevalent in healthcare and housing environments. Importantly, poverty and housing instability were not just common but appeared to amplify the experience of stigma, compounding the effects of identity-based marginalization. These results highlight the urgent need for integrated, affirming, and structurally responsive interventions tailored to the realities of multiply marginalized PLHIV in rural areas. Future research and services must consider the interplay of identity and economic precarity in order to promote equitable care and support.