Beyond an HIV Diagnosis: The Unheard Lived Experiences of Women Living with HIV in Gauteng Province, South Africa

Beyond an HIV Diagnosis: The Unheard Lived Experiences of Women Living with HIV in Gauteng Province, South Africa | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Beyond an HIV Diagnosis: The Unheard Lived Experiences of Women Living with HIV in Gauteng Province, South Africa Trevor Masevhege, Rebecca Skhosana This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7538508/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Background Globally, over 37 million individuals are infected with HIV, with women disproportionately affected. Women living with HIV (WLHIV) account for about 53% of all people living with HIV (PLHIV). This is due to factors like gender-based violence, stigma, socio-economic challenges, low economic status and gender disparities. Purpose This study explored the unheard lived experiences of WLHIV in coping with an HIV-positive diagnosis. Methods This study utilised a qualitative phenomenological design with 15 women living with HIV (WLHIV) from the Central Chronic Medication Dispensing and Distribution Programme (CCMDD) at the Winnie Mandela Clinic in Ekurhuleni, Gauteng Province, South Africa. Data was collected through semi-structured interviews and analysed using Tesch's approach, resulting in two main themes and six subthemes. The study ensured data accuracy and reliability through trustworthiness measures and adhered to ethical considerations throughout the research. Results The study found that women living with HIV (WLHIV) face various challenges, including denial of their HIV status, blame, and lifestyle changes. Key difficulties include stigma, rejection, trust issues, and financial hardships. These negative influences can lead to poor treatment adherence and an increased risk of HIV-related deaths. Conclusions and implications The contributions of this study will be diverse, providing significant benefits to academic, policy, and clinical fields. It is anticipated that the findings will assist in creating social work and public health interventions to support individuals facing these challenges and empower newly diagnosed women with HIV by equipping them with the skills to navigate these difficult experiences. Women Lived experiences HIV Living with HIV HIV positive diagnosis Stigma Figures Figure 1 1 Introduction HIV is one of the most serious public health threats of the 21st century, and over 40 million people have lost their lives and continue to die from HIV-related diseases [ 1 ]. Women consistently have higher rates of HIV infection compared to men and are at a greater risk of contracting the virus [ 2 ]. In the mid-90s, 20 million people were estimated to be living with HIV globally [ 3 ]. Since then, the prevalence of PLHIV has grown to 39 million globally as of 2022, with women and girls accounting for 53% (20.6 million) of all PLHIV globally [ 4 ]. While women constitute more than half of all PLHIV worldwide, the proportion of women with HIV varies significantly across different countries [ 5 ]. Estimates indicate that in the United Kingdom, one in three PLHIV are women; in India, nearly four out of ten are women; and in sub-Saharan Africa, almost six in ten are women [ 6 ]. The Sub-Saharan African region remains the most severely affected, with women bearing a disproportionate burden compared with men [ 7 ]. In Lesotho, a study found that the likelihood of women acquiring HIV increased with each year of age, beginning at 15 and peaking at 44 years [ 8 ]. The study also highlighted the significantly lower rates of new HIV infections in men than in women. Furthermore, another study in Kenya involving 308 Kenyan communities revealed that HIV prevalence among women was 32% higher than among men, with women aged 20 to 40 years being the most affected [ 9 ]. In South Africa, which is within the same region is globally recognised for having the highest HIV prevalence, with women showing a higher prevalence of living with the virus [ 10 ]. In 2022, it was estimated that there were 6 million WLHIV, compared to 2.4 million men [ 11 ]. Figure 1 provides valuable insights into the demographics of HIV infection within the country. Figure 1 illustrates the findings of a study conducted in South Africa across all nine provinces from January 2022 to April 2023 by the Sixth South African National HIV Prevalence, Incidence, Behaviour, and Communication Survey (SABSSM VI) [ 11 ]. The study aimed to compare HIV prevalence among women (females in red) and men (males in green) across different age groups in South Africa. The study found that women consistently had a higher HIV prevalence than males across all age groups, except for the 60–64 age group, where men were found to have a higher rate of 6%. The largest gap was observed in the 30–34 age group, which was the age group sampled for this study. The study highlights the significant impact of HIV/ Acquired Immunodeficiency Syndrome (AIDS) on women in South Africa, especially among young women, who are disproportionately affected by the virus. The higher prevalence of HIV among these age groups indicates that women are experiencing higher mortality rates due to AIDS-related illnesses. This information highlights a disheartening reality, clearly illustrating how HIV disproportionately affects women compared with men. This high HIV prevalence in women can largely be attributed to gender disparity in HIV prevalence, influenced by various social and economic factors that heighten their risk of HIV exposure and transmission [ 12 ]. These factors include experiencing gender-based violence, socio-economic status, and lack of information about HIV, stigma, financial strain, and psychological barriers [ 13 ]. 1.2 Determinants of HIV vulnerability among women GBV, deeply rooted in gender inequality, is one of the most prevalent human rights violations and significantly impacts WLHIV’s experiences [ 14 ]. Women, who constitute the majority of GBV victims, are disproportionately affected by HIV, with numerous studies indicating a direct link between GBV and an increased risk of HIV infection [ 14 ]. Experiences of sexual violence, trauma, and abuse not only heighten vulnerability to HIV but also diminish women's ability to negotiate safe sexual practices [ 15 ]. These traumatic experiences further compromise the immune system and exacerbate the health challenges faced by WLHIV [ 15 ]. Additionally, young women encounter significant obstacles in accessing and utilising HIV prevention methods because of fear, lack of decision-making power, and threats of violence from their partners [ 16 ]. The lack of knowledge and awareness of HIV, particularly concerning risk factors, complicates the development of effective prevention frameworks. A study in Malawi revealed that men possessed more knowledge about HIV than women, thereby placing women at a greater risk [ 17 ]. Similarly, research in Ghana showed that women with limited understanding face challenges in protecting themselves and negotiating safe sex [ 18 ]. In South Africa, it was discovered that young adult women in high HIV-burden districts lack fundamental information about transmission and protection [ 19 ]. This knowledge gap, fuelled by societal norms and gender inequalities, leads to increased risky behaviours and higher HIV infection rates. Moreover, stigma and discrimination when seeking information hinder young women from comprehending their risks [ 20 ]. These findings highlight the lower education levels among women compared to men, contributing to the higher rates of WLHIV. The rising rate of HIV infections among women and the increasing number of HIV-related deaths have led the scientific community to seek a cure [ 21 ]. While a cure has yet to be found, the development of Antiretrovirals (ARVs) in the 1980s transformed HIV from a potentially fatal virus into a manageable chronic condition [ 22 ]. The World Health Organisation (WHO) recommends that ARVs be provided free of charge to all individuals diagnosed with HIV in public health facilities worldwide, regardless of their clinical stage [ 22 ]. However, WLHIV continue to face challenges that lead to non-adherence to treatment, missed clinic appointments, and an increased risk of morbidity and death from HIV-related diseases. 1.3 Multidimensional challenges confronting WLHIV Chronic illnesses, such as HIV, present unique challenges for those affected, particularly WLHIV [ 23 ]. These women face multiple obstacles, including stigma, financial burden, and psychological difficulties [ 23 ]. Scholars have identified three main types of stigma affecting WLHIV: anticipatory, enacted, and internalised [ 24 ]. Anticipatory stigma involves the fear of rejection if one's HIV status becomes known, often intensified by historical associations between HIV and promiscuity. Enacted stigma encompasses tangible acts of discrimination, exclusion and abuse. Internalised stigma occurs when individuals absorb and accept negative societal attitudes, leading to feelings of shame and low self-worth. Stigma significantly impacts the mental and physical health of WLHIV, often resulting in social withdrawal and reluctance to seek help [ 25 ]. This creates a cycle of marginalisation that hinders their ability to live openly, access care, and thrive in society. Research in South Africa has shown that women experiencing less stigma are twice as likely to adhere to ARV treatment compared with those facing higher levels of stigma [ 26 ]. WLHIV also face significant mental health challenges, with depression being particularly common [ 27 ]. Factors contributing to this include caregiving burdens, lower income, personal experiences, inadequate education, and lack of social support [ 23 ]. An HIV diagnosis can be life-changing, leading to feelings of powerlessness, anxiety, and fear of disclosure [ 28 ]. A study in Gauteng, South Africa, found that postpartum depression (PPD) was more prevalent among WLHIV (28%) than among HIV-negative women (23%). Living arrangements emerged as significant predictors of PPD, with women living alone being more susceptible to depression [ 28 ]. Overall, the high prevalence of depression among WLHIV highlights the need to address mental health issues, which are crucial for their well-being and effective management of HIV. The psychological impact of HIV on women is significant, but the virus also imposes considerable financial burdens, especially on those from low-income backgrounds or the unemployed [ 29 ]. Despite free treatment at most public health facilities, women often incur substantial costs for healthcare, diet, transportation, and other necessities [ 30 ]. These expenses can lead to family poverty and reduced educational opportunities. For example, WLHIV in Nepal spend approximately US $ 20.10 monthly on treatment, a significant burden compared to the average monthly wage of just over US $ 100.00.) [ 30 ]. In India, high transportation costs contribute to the discontinuation of ARV therapy [ 31 ], a trend also seen in Zambia and South Africa [ 29 , 32 ]. These financial pressure affects their adherence to treatment, which is a global health priority. Women also face a heavier burden due to societal roles, which are exacerbated by physiological and socio-structural factors [ 33 ]. In many underdeveloped countries, women manage household duties, including childcare and caring for partners. These responsibilities, combined with their HIV status, can lead to depression and difficulties with treatment adherence [ 33 ], highlighting the urgent need for gender-sensitive healthcare services that address both the medical and psychosocial needs of WLHIV, considering their caregiving roles. Without targeted interventions, the impact of HIV, maternal obligations, and cultural norms may undermine treatment adherence and long-term health outcomes. While extensive research on HIV exists, there has been limited focus on the experiences of women following a positive diagnosis, particularly in South Africa. This study aimed to highlight the vulnerabilities faced by WLHIV and the challenges that impact their health, treatment adherence, and overall well-being. Using in-depth interviews, this study explored the lived experiences of WLHIV coping with their diagnosis, offering valuable insights to inform public health and social work interventions, improve coping strategies, and enhance psychosocial support for this vulnerable group. 2 Methods A qualitative research approach was employed to explore human behaviour, attitudes, and lived experiences in natural contexts [ 35 ]. This approach was suitable for understanding the experiences and challenges faced by WLHIV coping with their diagnosis. The study used a phenomenological design to capture WLHIV’s narratives regarding their social, psychological, economic, and health-related difficulties [ 36 ]. 2.1 Study site The research took place in an informal settlement in Gauteng, South Africa, which has one of the highest HIV prevalence rates, with approximately 64% of PLHIV being women [ 37 ]. This location was chosen to gain insight into WLHIV's experiences in a socioeconomically disadvantaged environment. 2.2 Selection sample The study focused on WLHIV aged 20 to 40 who resided at the informal settlement and were enrolled in the Central Chronic Medicine Dispensing and Distribution (CCMDD) program at the local clinic. Purposive sampling was used to select participants with relevant characteristics according to the inclusion and exclusion criteria outlined in Table 1 . Table 1 Inclusion and exclusion criteria Inclusion criteria Exclusion criteria • Participants had to be WLHIV aged between 20 and 40 years. • Participants had to have been living with HIV for over 5 years. To confirm this, the researcher asked confirmation questions like, "How long have you been living with HIV?" • The participants had to be residents of the selected informal settlement. • The participants had to be part of the CCMDD program at the local clinic • Participants had to be able to speak English, Xitsonga, Tshivenda, Sepedi, or Isizulu. The researcher is fluent in all of these languages. • Women aged 20 to 40 years who were not living with HIV. • WLHIV who were below 20 years or above 40 years of age. • WLHIV who met the criteria but did not live at the selected informal settlement. • WLHIV who met the criteria but were not enrolled in the CCMDD program at the local clinic. • WLHIV who met the criteria but did not speak English, Xitsonga, Tshivenda, Sepedi, or Isizulu. 2.3 Ethical considerations Before the study began, ethical clearance was obtained from the Institutional Research Ethics Committee, number # Rec-240816-052. Approval was then granted by the local council to access the informal settlement. Subsequently, permission was sought from the Department of Health in Gauteng to sample participants from their health facility and to request assistance from the decanting facilitator for participant recruitment, both of which were approved. Ethical clearance was obtained from the relevant institutional ethics committee and the authorities. Key ethical principles adhered to included informed consent, confidentiality, anonymity, beneficence, debriefing, and avoidance of harm [ 44 ]. 2.4 Data collection Recruitment was facilitated through the local clinic decanting team, who introduced the study during the CCMDD sessions. All participants provided written informed consent. Data was collected through semi-structured, face-to-face interviews guided by an interview guide. This approach ensured consistency while allowing participants to elaborate on their experiences and challenges [ 39 ]. Fifteen participants were interviewed, each choosing a convenient location for their one-on-one interviews to ensure confidentiality. Most participants preferred to be interviewed in their homes, as they found it more private and secure. Each interview lasted 45–60 minutes, and to protect participants' privacy, numbers were used to refer to them [ 40 ]. All interviews were audio-recorded with consent and transcribed verbatim. A pilot study involving three participants who met the inclusion criteria was conducted to test the clarity and relevance of the interview guide [ 41 ]. Minor adjustments were made, and pilot data were excluded from the final analysis and report. COVID-19 protocols were followed throughout the study. Data saturation determined the final sample size, with recruitment ceasing when no new themes emerged [ 38 ].The following research question guided the interviews: What are the lived experiences of women living with HIV in coping with an HIV-positive diagnosis? 2.5 Data analysis This study followed Tesch’s method of qualitative data analysis by Creswell [ 42 ]. This process involved reading all transcripts for a general sense of the data, identifying significant statements, developing codes, grouping codes into themes and subthemes, and refining these to ensure they accurately reflected the participants’ accounts. 2.6 Data verification Trustworthiness was ensured using Lincoln and Guba’s (1986) framework of credibility, transferability, dependability and confirmability [ 43 ]. Credibility was strengthened through member checking, and detailed descriptions of the research context enhanced transferability. Dependability and confirmability were supported by maintaining an audit trail documenting each stage of the research process. 3 Results In this section, we present the findings of our study, along with an analysis and discussion of the results. Table 2 provides an overview of the participants’ biographical backgrounds, which is essential for understanding the context and diversity of the sample. This background information will help elucidate the subsequent findings and discussions. Table 2 Participant Biographic Background Participants Age Ethnic group Period Living with HIV Part of CCMDD 1 37 Venda 5 Yes 2 32 Zulu 6 Yes 3 39 Pedi 13 Yes 4 35 Venda 12 Yes 5 40 Tsonga 19 Yes 6 31 Tsonga 7 Yes 7 32 Zulu 10 Yes 8 29 Tsonga 6 Yes 9 39 Tsonga 11 Yes 10 40 Venda 15 Yes 11 33 Pedi 5 Yes 12 32 Pedi 8 Yes 13 27 Tsonga 7 Yes 14 35 Pedi 8 Yes 15 29 Tsonga 5 Yes Table 2 provides details about the study participants, who were assigned numbers for confidentiality purposes. The study involved fifteen WLHIV from an informal settlement in Gauteng, South Africa. Although twenty-five interviews were planned, data saturation was achieved with fifteen participants aged 27–40 years, with none withdrawing after consenting. This age range is known for greater life stability and health awareness, which aligns with findings that women in their late 20s to 40s are more motivated to contribute to community health [ 45 ]. All participants had been living with HIV for at least five years (5–19 years), which was associated with improved self-management and resilience [ 46 ] and were enrolled in the CCMDD program. All participants were Black African residents from four dominant ethnic groups: Vatsonga (n = 6), Bapedi (n = 4), Vhavenda (n = 3), and Zulu (n = 2), reflecting the area's demographic profile (Marutlulle, 2017). Interviews were conducted in their preferred language, primarily Xitsonga. The following Table 3 summarises the two main themes and six subthemes identified in the analysis. Table 3 Themes and sub-themes THEMES SUB-THEMES Theme 1: Life after testing HIV-positive Sub-theme 1.1: Denial of one’s HIV status, Sub-theme 1.2: Blaming others Sub-theme 1.3: Lifestyle re-adjustment Theme 2: Challenges faced by women living with HIV Sub-theme 2.1: Stigmatisation and rejection Sub-theme 2.2: Trust deficit among WLHIV Sub-theme 2.3: Financial difficulties. Theme 1: Life after testing HIV-positive This theme explores the journeys and experiences of women who tested positive for HIV. It delves into the emotional, social, and health-related challenges they face, as well as the personal growth and resilience that can emerge from such a life-altering diagnosis. It highlights the importance of support systems, access to medical care, and ongoing conversations about living well with HIV. The following subthemes were identified as common reactions derived from the findings: Sub-theme 1.1: Denial of one’s HIV status The study findings revealed that prior to acceptance, participants commonly experienced denial upon discovering their HIV-positive status. As one participant stated: “Well, my life has not changed much; the only difficulty I had was in the beginning because I was frightened. It took me a little longer to accept that I am HIV positive.” (P14). Such reactions are not unusual, as individuals rarely anticipate contracting HIV until after diagnosis. Denial serves as a psychological defence mechanism that shields individuals from overwhelming fear and distress [ 47 ]. However, while some confront denial quickly, others remain trapped in it, delaying treatment initiation. Denial is a protective barrier against difficult realities, despite medical advances and wider societal acceptance of HIV [ 47 ]. Lifestyle perceptions also emerged as factors influencing denial. Some participants measured their likelihood of infection against their personal choices, often ignoring the risks posed by their partners. This dissonance between perceived low-risk behaviour and an HIV-positive diagnosis fosters denial as a means of preserving self-image [ 48 ]. “It was very difficult for me to accept because I knew that things like HIV are far from me because of my lifestyle. I have one boyfriend, so I kept asking myself what happened. It was very difficult for me.” (P8). Denial also reflects deeper psychological struggles, including fear of stigma, shame, and uncertainty about the future [ 49 ]. For many, rejecting the diagnosis is a way to maintain control and avoid confronting mortality [ 48 ]. Cognitive dissonance, the conflict between prior beliefs and the imposed reality of diagnosis, further intensifies reliance on denial as a coping mechanism [ 48 ]. Sub-theme 1.2: Blaming others The study findings indicate that many participants struggled to take responsibility or demonstrate accountability after receiving positive HIV test results. Men were often identified as central to HIV transmission; however, support from partners also emerged as a source of hope. Anger was a dominant theme, as one participant stated: “I was very angry from my past relationship because my then-boyfriend used to abuse me, learning that I am HIV positive fuelled the anger because I knew that I got it from him, because I have never cheated, but after attending church and counselling, I managed to deal with the anger and forgave him.” (P9) Participants frequently attributed their HIV status to others, a response shaped by the social stigma surrounding HIV [ 50 ]. Blaming others appeared to provide emotional relief, although it complicated the process of acceptance. Many described feeling victimised by their partners, as illustrated below: "I have accepted being HIV positive, but it has changed how I view men. I believe my ex-boyfriend infected me, and I separated from a supportive partner who was scared. Now, it's hard to find men who accept my status; they often disappear after I disclose it." (P13) "I felt my life turn upside down when I discovered I had HIV. My husband, my high school boyfriend of 18 years, had cheated, and despite my love and loyalty, I never expected this outcome." (P11) Blame is used as a coping mechanism to ease distress, fear, and guilt. It is initially served to protect self-esteem and provide a sense of control over time. The tendency to blame is further reinforced by the pervasive stigma attached to HIV, which remains associated with immorality [ 20 ]. Internalised stigma often heightens shame, while misconceptions about transmission contribute to perceptions of being infected through others’ negligence or betrayal. Sub-theme 1.3: Lifestyle Re-adjustment The study findings revealed that living with HIV necessitates significant lifestyle modifications, supporting the adage that change is a challenging process. Participants described adjustments ranging from dietary changes and treatment adherence to relationship losses when their partners could not sustain the relationship. "Living with HIV does not stop me from chasing my dreams. At 29, I encourage other women to stick to their treatment and adopt a healthy lifestyle to boost their immune systems." HIV diagnosis often heightens stress levels, adversely affecting both physical and mental health [ 51 ]. Effective stress management through mindfulness, yoga, or deep breathing is critical for immune system protection [ 52 ]. Diet also plays a central role, with nutrient-rich foods and probiotics being vital for maintaining immune function [ 53 ]. However, participants admitted to having initial knowledge gaps. “The only thing I knew was that HIV does not kill you when you take your medication consistently; However, I did not know about changing your whole lifestyle, adjusting food, and the possibility of being reinfected. I felt like I did not know anything.” (P2). Substance abuse, including alcohol and drug use, has also been identified as a critical risk factor that compromises adherence and immune strength [ 54 ]. For some, this required a profound shift in their behaviour. "I used to eat anything and drink alcohol while partying. However, after researching the impact on my health, I realised I needed to eat healthier and stop drinking. Consequently, I changed my lifestyle."(P4) Beyond nutrition and substance use, physical exercise is essential for quality of life. Studies have confirmed that regular activity enhances the immune response, alleviates HIV-related symptoms, and prevents secondary conditions associated with sedentary living [ 55 ]. Strength training further supports muscle mass and bone density, whereas aerobic exercise improves cardiovascular fitness and mental well-being [ 56 ]. Theme 2: Challenges faced by WLHIV The study identified several primary challenges faced by WLHIV after testing positive for HIV. These include HIV-related stigmatisation and rejection, a trust deficit among WLHIV, and financial difficulties. Sub-theme 2.1: Stigmatisation and Rejection The findings of this study show that WLHIV frequently encounter various forms of social stigmatisation and rejection. Some participants experienced social isolation or were unwelcome within the larger community because of their HIV status. This stigmatisation and rejection are also experienced within their immediate circles, including family members, friends, and partners. As a result of the fear of facing stigmatisation and rejection, WLHIV expressed a preference for remaining single due to apprehension about potential rejection based on their HIV status. “Yes, I think it is like any illness; the main difference is the constant awareness of it. For me, the hardest part has been dating, as I now have to disclose my condition. What if he rejects me?” (P2) "One challenge I face as a woman living with HIV is starting new relationships. Disclosing my status is essential, but it’s still difficult. No matter how clearly I explain HIV, individuals often have their own views that may differ from mine."(P8) Changes in our lives can significantly impact us, leading to positive or negative outcomes. A prime example is discovering one's HIV status, which can evoke considerable fear and anxiety, particularly if the test result is positive [ 57 ]. WLHIV continue to encounter significant challenges, particularly stigma and rejection [ 20 ]. This persists despite advancements in medical treatment and public health education [ 20 ]. Stigma manifests through discrimination, prejudice, and rejection, which can have serious psychosocial and health consequences for those affected by it [ 27 ]. The detrimental effects of such stigmatisation and rejection can lead to hesitancy in disclosing one's HIV-positive status to partners or family members because of fear of negative repercussions on their relationships. This fear of discrimination may deter WLHIV from seeking testing and treatment, resulting in delayed diagnosis and increased transmission rates [ 58 ]. Furthermore, fear of societal judgment and rejection compels WLHIV to conceal their status, often leading to isolation and a lack of social support. Consequently, the absence of support and meaningful connections can adversely affect their mental, emotional, and physical health, contributing to higher rates of depression, anxiety, and substance abuse [ 59 ]. Sub-theme 2.2: A trust deficit among WLHIV The study findings revealed that fear of stigmatisation and discrimination significantly contributed to the trust deficit experienced by WLHIV. Consequently, women often hesitate to trust men or disclose their HIV status because they fear abandonment, judgment or rejection. Participants described how these experiences eroded their abilities to form new relationships. “I struggled to trust men after what happened, and I even stopped dating for almost two years. Other challenges would be the same as everyone who is living with HIV Some people don’t know about HIV, so they discriminate against us and don’t want to be associated with that, but for me now, I have accepted.” (P7). “I will say it is no longer easy for me to trust men, and it is also a challenge when men leave me after they learn my status. I am now single and happy; I don’t want any relationship because I fear that it won't last after they know my status and they start to stigmatise me.” (P9). Harmful gender norms and stereotypes intensify stigma, producing negative societal attitudes and internalised feelings of shame [ 60 ]. Lack of trust following an HIV diagnosis carries severe psychological and emotional consequences. Trust, which ordinarily rests on loyalty, honesty and emotional support, is profoundly disrupted by fears of infidelity, non-disclosure, and blame [ 61 ]. Furthermore, unequal gender power dynamics worsen mistrust. Historically, women’s dependence on men for emotional and financial support has created such vulnerabilities [ 62 ]. An HIV diagnosis amplifies these imbalances and deepens feelings of betrayal. Many participants expressed distrust of men, viewing them as responsible for HIV transmission, which in turn contributed to relationship breakdowns and separations from their partners. Sub-them 2.3: Financial difficulties The study also found that financial hardships prevented some women from coping with their HIV diagnosis. Participants pointed out that expenses related to transportation to the clinic for medication collection and adherence to a prescribed diet were especially difficult, particularly for those who were unemployed. Consequently, this hinders their adherence to the treatment plan and their ability to attend clinic appointments as scheduled, which is contrary to the behaviour of someone aiming to be resilient to HIV. “Yes, another challenge was the issue of food, as they say you need to eat specific food types, which I could not afford because I am unemployed. I rely on my boyfriend for money for taxi fares so I can go collect my medication”. (P4). “The biggest challenge I face is disclosing my status to men I'm interested in. Many pull away due to misconceptions about the disease, making it hard to find love. I'm also unemployed, so I struggle to afford clinic visits, though my family sometimes helps me with the costs.” (P9) According to the definition of resilience, a resilient person is someone who can use their resources to find solutions to the problems they face [ 63 ]. In this case, economic disparities played a crucial role in worsening the situation for WLHIV. Women often have less economic independence and face more financial obstacles, especially in developing countries [ 64 ]. This economic disadvantage limits their ability to access necessary healthcare and to follow treatment plans [ 65 ]. Additionally, the lack of economic resources increases their vulnerability to other health challenges, such as malnutrition and poor mental well-being, which further amplifies the impact of HIV on women's overall health [ 65 ]. The financial difficulties that WLHIV experience are one of the contributing factors to the majority of WLHIV failing to cope with their HIV diagnosis. 4 Discussion This study explored the lived experiences of women living with HIV following their diagnosis, revealing a complex journey marked by significant psychological distress, social challenges, and adaptation. These findings align with and extend the existing literature on HIV, highlighting that a positive diagnosis remains a profoundly life-altering event that necessitates considerable psychological and lifestyle adjustments, even in the era of effective antiretroviral therapy. The initial reaction of denial emerged as a critical first response to an HIV-positive diagnosis. This finding is consistent with established psychological models of grief and loss, wherein denial functions as a protective mechanism against overwhelming information [ 66 ]. The participants' narratives, such as measuring their perceived low-risk lifestyle against the reality of their diagnosis, exemplified cognitive dissonance. This dissonance between self-perception and a stigmatised illness can foster denial as individuals struggle to integrate the new, threatening identity of being a person living with HIV into their existing self-concept [ 67 ]. However, prolonged denial poses a significant barrier to engaging in care. Recent research underscores that rapid ART initiation is crucial for both individual health and prevention efforts, making the timely transition from denial to acceptance a critical public health objective [ 68 ]. Closely linked to denial was the tendency to blame others, particularly male partners, for HIV transmission. This coping strategy can be understood as an attempt to manage intense emotions, such as anger, shame, and a perceived loss of control. While blame may offer temporary emotional relief, it can complicate long-term acceptance and trust in future relationships. This finding is closely intertwined with gendered power dynamics; in many contexts, HIV stigma is heavily gendered and associated with moral judgments about sexuality [ 69 ]. Women often bear a disproportionate burden of this stigma, and blaming a partner can be a way to deflect this perceived immorality and preserve their self-esteem. Furthermore, scholars continue to highlight that intimate partner violence and gender inequality are significant drivers of HIV risk for women and barriers to disclosure and care post-diagnosis [ 70 , 71 ], providing a contextual backdrop for the anger and blame expressed by participants. A cornerstone of living well with HIV is lifestyle re-adjustment. Participants described comprehensive changes, including dietary improvements, substance use cessation, and exercise, which are well documented to support immune function and overall quality of life [ 72 , 73 ]. However, the initial lack of knowledge reported by participants points to a potential gap in post-test counselling services. Moving beyond basic ART adherence education to include holistic nutritional, mental health, and physical activity guidance is increasingly recognised as the best practice in HIV care [ 74 ]. The journey from initial ignorance to empowered self-management, as described by some participants, illustrates the development of health literacy as a key component of resilience and long-term health outcomes for WLHIV. The challenges of stigmatisation and rejection remain formidable barriers, corroborating global research that, despite medical advances, social attitudes have not progressed at the same pace [ 20 ]. The fear of rejection led many participants to withdraw from dating or anticipate relationship dissolution upon disclosure of their status. This internalised and anticipated stigma can be as damaging as enacted stigma, leading to social isolation, poor mental health, and deterring individuals from accessing care to keep their status secret [ 27 ]. A recent study by Inglis confirmed that harmful gender norms continue to intensify this stigma, creating an environment where WLHIV are unfairly judged [ 75 ]. This pervasive stigma directly fuels trust deficits, particularly towards men and potential new partners. The erosion of trust described by the participants disrupts a fundamental element of human connection and social support. As some scholars argue, trust is built on honesty and emotional safety, which are shattered by experiences of betrayal and fear of rejection [ 57 , 76 ]. This finding is critical because social support is a well-established predictor of ART adherence and mental well-being. Without interventions to rebuild trust and foster supportive partnerships, WLHIV may remain isolated, negatively impacting their health. Finally, the theme of financial difficulty underscores the stark intersection between health and socioeconomic status. The participants' struggles with the costs of transport and nutritious food highlight how poverty is a primary barrier to resilience. For one to be resilient to HIV, they require access to resources to overcome such adversity [ 77 ]. For WLHIV, economic vulnerability can directly undermine clinical outcomes by hindering clinic attendance and the ability to maintain a healthy lifestyle [ 77 ]. This is exacerbated by the fact that women, particularly in certain regions, often have less economic independence [ 64 ]. Recent economic shocks, such as the COVID-19 pandemic, have further exposed and deepened these health inequities, disproportionately affecting the care continuum for WLHIV [ 78 ]. 5 Conclusion In conclusion, the journey after an HIV-positive diagnosis for the women in this study is a testament to the ongoing interplay between biomedical, psychological, and social factors. While ART has transformed HIV into a manageable chronic condition, the lived experience is still shaped by stigma, gender inequality, and economic hardship. These findings have several implications: Clinical Practice: Post-test counselling and ongoing care must move beyond biological management to address psychological reactions (e.g., denial and blame) and provide concrete, holistic education on lifestyle adjustments. Mental Health Support: Integrated mental health services are essential for helping individuals process trauma, anger, and distrust and develop healthy coping strategies to mitigate isolation. Stigma Reduction: Public health campaigns must evolve to address the persistent, gendered nature of HIV stigma and promote messages that normalise living with HIV. Structural Interventions: Policy efforts must address the structural barriers, particularly poverty and gender inequality, that underpin many of these challenges. This could include supporting programs that provide nutritional support, transport vouchers, and economic empowerment opportunities for WLHIV. Although this study was limited by its focus on a specific population, it provides rich insights into the experiences and challenges of WLHIV. Future research should broaden the scope to include more diverse participants and explore the long-term outcomes of trust deficits, stigma, and economic disparities. In the South African context, where structural inequalities remain entrenched, addressing these challenges is not only a matter of health but also of social equity. Future research should continue to explore interventions that effectively build resilience, foster social support, and empower WLHIV to navigate these complex challenges and lead healthy and fulfilling lives. These experiences are not isolated but are deeply embedded within gendered power dynamics, societal attitudes, and structural inequalities that continue to marginalise WLHIV. The erosion of trust, both in intimate relationships and in wider social networks, was particularly damaging, as it heightened feelings of isolation, rejection, and vulnerability to depression and anxiety. Moreover, financial difficulties were shown to be a major barrier, limiting access to healthcare, adherence to treatment, and the ability to live healthily. Collectively, these findings underscore the need for a holistic response that goes beyond medical treatment to include psychosocial support, economic empowerment, and stigma reduction interventions. Declarations Conflict of interest The authors declare no conflict of interest. Consent to Participate declaration All participants provided written informed consent. Consent for publication Not applicable. Ethical approval The study was approved by the University of South Africa Research Ethics Committee, Ref number: # Rec-240816-052. Approval was then granted by the local council to access the informal settlement. Subsequently, permission was sought from the Department of Health in Gauteng, South Africa. Clinical trial number Not applicable Funding This study was not funded by any external sources; it was self-funded. Author Contribution The TM participated in the conception, design, data collection, data analysis, and drafting of the initial manuscript. The RM supervised the research and critically reviewed the manuscript. All authors approved the final version of the manuscript. Acknowledgements We express our gratitude to all the WLHIV who participated in this research, the Gauteng Department of Health, and the local councillor of the informal settlement for permitting us to conduct the study in their health facility and community. We also thank the officials at the health facility who assisted in identifying the study’s participants. Data Availability All relevant data are included in the article. However, more information is available upon reasonable request from the corresponding author. References Swinkels H, Nguyen A, Gulick P. HIV and AIDS. StatPearls. 2024. Mannell J, Willan S, Shahmanesh M, Seeley J, Sherr L, Gibbs A. Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa. J Int AIDS Soc. 2019;22(8):e25380. Hemelaar J, Elangovan R, Yun J, Dickson-Tetteh L, Kirtley S, Gouws-Williams E, et al. Global and regional epidemiology of HIV-1 recombinants in 1990–2015: a systematic review and global survey. 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COVID-19 Pandemic Disrupts HIV Continuum of Care and Prevention: Implications for Research and Practice Concerning Community-Based Organisations and Frontline Providers. AIDS Behav. 2020;24(9):2486–9. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 16 Oct, 2025 Reviews received at journal 06 Oct, 2025 Reviews received at journal 05 Oct, 2025 Reviewers agreed at journal 29 Sep, 2025 Reviewers agreed at journal 26 Sep, 2025 Reviewers agreed at journal 20 Sep, 2025 Reviewers invited by journal 18 Sep, 2025 Editor invited by journal 11 Sep, 2025 Editor assigned by journal 11 Sep, 2025 Submission checks completed at journal 11 Sep, 2025 First submitted to journal 04 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Women consistently have higher rates of HIV infection compared to men and are at a greater risk of contracting the virus [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the mid-90s, 20\u0026nbsp;million people were estimated to be living with HIV globally [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Since then, the prevalence of PLHIV has grown to 39\u0026nbsp;million globally as of 2022, with women and girls accounting for 53% (20.6\u0026nbsp;million) of all PLHIV globally [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. While women constitute more than half of all PLHIV worldwide, the proportion of women with HIV varies significantly across different countries [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Estimates indicate that in the United Kingdom, one in three PLHIV are women; in India, nearly four out of ten are women; and in sub-Saharan Africa, almost six in ten are women [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe Sub-Saharan African region remains the most severely affected, with women bearing a disproportionate burden compared with men [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Lesotho, a study found that the likelihood of women acquiring HIV increased with each year of age, beginning at 15 and peaking at 44 years [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The study also highlighted the significantly lower rates of new HIV infections in men than in women. Furthermore, another study in Kenya involving 308 Kenyan communities revealed that HIV prevalence among women was 32% higher than among men, with women aged 20 to 40 years being the most affected [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In South Africa, which is within the same region is globally recognised for having the highest HIV prevalence, with women showing a higher prevalence of living with the virus [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In 2022, it was estimated that there were 6\u0026nbsp;million WLHIV, compared to 2.4\u0026nbsp;million men [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides valuable insights into the demographics of HIV infection within the country.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the findings of a study conducted in South Africa across all nine provinces from January 2022 to April 2023 by the Sixth South African National HIV Prevalence, Incidence, Behaviour, and Communication Survey (SABSSM VI) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The study aimed to compare HIV prevalence among women (females in red) and men (males in green) across different age groups in South Africa. The study found that women consistently had a higher HIV prevalence than males across all age groups, except for the 60\u0026ndash;64 age group, where men were found to have a higher rate of 6%. The largest gap was observed in the 30\u0026ndash;34 age group, which was the age group sampled for this study.\u003c/p\u003e\u003cp\u003eThe study highlights the significant impact of HIV/ Acquired Immunodeficiency Syndrome (AIDS) on women in South Africa, especially among young women, who are disproportionately affected by the virus. The higher prevalence of HIV among these age groups indicates that women are experiencing higher mortality rates due to AIDS-related illnesses. This information highlights a disheartening reality, clearly illustrating how HIV disproportionately affects women compared with men. This high HIV prevalence in women can largely be attributed to gender disparity in HIV prevalence, influenced by various social and economic factors that heighten their risk of HIV exposure and transmission [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These factors include experiencing gender-based violence, socio-economic status, and lack of information about HIV, stigma, financial strain, and psychological barriers [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec2\" class=\"Section2\"\u003e\u003ch2\u003e1.2 Determinants of HIV vulnerability among women\u003c/h2\u003e\u003cp\u003eGBV, deeply rooted in gender inequality, is one of the most prevalent human rights violations and significantly impacts WLHIV\u0026rsquo;s experiences [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Women, who constitute the majority of GBV victims, are disproportionately affected by HIV, with numerous studies indicating a direct link between GBV and an increased risk of HIV infection [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Experiences of sexual violence, trauma, and abuse not only heighten vulnerability to HIV but also diminish women's ability to negotiate safe sexual practices [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. These traumatic experiences further compromise the immune system and exacerbate the health challenges faced by WLHIV [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Additionally, young women encounter significant obstacles in accessing and utilising HIV prevention methods because of fear, lack of decision-making power, and threats of violence from their partners [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe lack of knowledge and awareness of HIV, particularly concerning risk factors, complicates the development of effective prevention frameworks. A study in Malawi revealed that men possessed more knowledge about HIV than women, thereby placing women at a greater risk [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Similarly, research in Ghana showed that women with limited understanding face challenges in protecting themselves and negotiating safe sex [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In South Africa, it was discovered that young adult women in high HIV-burden districts lack fundamental information about transmission and protection [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This knowledge gap, fuelled by societal norms and gender inequalities, leads to increased risky behaviours and higher HIV infection rates. Moreover, stigma and discrimination when seeking information hinder young women from comprehending their risks [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These findings highlight the lower education levels among women compared to men, contributing to the higher rates of WLHIV.\u003c/p\u003e\u003cp\u003eThe rising rate of HIV infections among women and the increasing number of HIV-related deaths have led the scientific community to seek a cure [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. While a cure has yet to be found, the development of Antiretrovirals (ARVs) in the 1980s transformed HIV from a potentially fatal virus into a manageable chronic condition [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The World Health Organisation (WHO) recommends that ARVs be provided free of charge to all individuals diagnosed with HIV in public health facilities worldwide, regardless of their clinical stage [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, WLHIV continue to face challenges that lead to non-adherence to treatment, missed clinic appointments, and an increased risk of morbidity and death from HIV-related diseases.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e1.3 Multidimensional challenges confronting WLHIV\u003c/h2\u003e\u003cp\u003eChronic illnesses, such as HIV, present unique challenges for those affected, particularly WLHIV [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. These women face multiple obstacles, including stigma, financial burden, and psychological difficulties [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Scholars have identified three main types of stigma affecting WLHIV: anticipatory, enacted, and internalised [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Anticipatory stigma involves the fear of rejection if one's HIV status becomes known, often intensified by historical associations between HIV and promiscuity. Enacted stigma encompasses tangible acts of discrimination, exclusion and abuse. Internalised stigma occurs when individuals absorb and accept negative societal attitudes, leading to feelings of shame and low self-worth. Stigma significantly impacts the mental and physical health of WLHIV, often resulting in social withdrawal and reluctance to seek help [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. This creates a cycle of marginalisation that hinders their ability to live openly, access care, and thrive in society. Research in South Africa has shown that women experiencing less stigma are twice as likely to adhere to ARV treatment compared with those facing higher levels of stigma [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWLHIV also face significant mental health challenges, with depression being particularly common [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Factors contributing to this include caregiving burdens, lower income, personal experiences, inadequate education, and lack of social support [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. An HIV diagnosis can be life-changing, leading to feelings of powerlessness, anxiety, and fear of disclosure [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. A study in Gauteng, South Africa, found that postpartum depression (PPD) was more prevalent among WLHIV (28%) than among HIV-negative women (23%). Living arrangements emerged as significant predictors of PPD, with women living alone being more susceptible to depression [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Overall, the high prevalence of depression among WLHIV highlights the need to address mental health issues, which are crucial for their well-being and effective management of HIV.\u003c/p\u003e\u003cp\u003eThe psychological impact of HIV on women is significant, but the virus also imposes considerable financial burdens, especially on those from low-income backgrounds or the unemployed [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. Despite free treatment at most public health facilities, women often incur substantial costs for healthcare, diet, transportation, and other necessities [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. These expenses can lead to family poverty and reduced educational opportunities. For example, WLHIV in Nepal spend approximately US\u003cspan\u003e$\u003c/span\u003e20.10 monthly on treatment, a significant burden compared to the average monthly wage of just over US\u003cspan\u003e$\u003c/span\u003e100.00.) [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. In India, high transportation costs contribute to the discontinuation of ARV therapy [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e], a trend also seen in Zambia and South Africa [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. These financial pressure affects their adherence to treatment, which is a global health priority.\u003c/p\u003e\u003cp\u003eWomen also face a heavier burden due to societal roles, which are exacerbated by physiological and socio-structural factors [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In many underdeveloped countries, women manage household duties, including childcare and caring for partners. These responsibilities, combined with their HIV status, can lead to depression and difficulties with treatment adherence [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], highlighting the urgent need for gender-sensitive healthcare services that address both the medical and psychosocial needs of WLHIV, considering their caregiving roles. Without targeted interventions, the impact of HIV, maternal obligations, and cultural norms may undermine treatment adherence and long-term health outcomes.\u003c/p\u003e\u003cp\u003eWhile extensive research on HIV exists, there has been limited focus on the experiences of women following a positive diagnosis, particularly in South Africa. This study aimed to highlight the vulnerabilities faced by WLHIV and the challenges that impact their health, treatment adherence, and overall well-being. Using in-depth interviews, this study explored the lived experiences of WLHIV coping with their diagnosis, offering valuable insights to inform public health and social work interventions, improve coping strategies, and enhance psychosocial support for this vulnerable group.\u003c/p\u003e\u003c/div\u003e"},{"header":"2 Methods","content":"\u003cp\u003eA qualitative research approach was employed to explore human behaviour, attitudes, and lived experiences in natural contexts [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This approach was suitable for understanding the experiences and challenges faced by WLHIV coping with their diagnosis. The study used a phenomenological design to capture WLHIV\u0026rsquo;s narratives regarding their social, psychological, economic, and health-related difficulties [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Study site\u003c/h2\u003e\u003cp\u003eThe research took place in an informal settlement in Gauteng, South Africa, which has one of the highest HIV prevalence rates, with approximately 64% of PLHIV being women [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. This location was chosen to gain insight into WLHIV's experiences in a socioeconomically disadvantaged environment.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Selection sample\u003c/h2\u003e\u003cp\u003eThe study focused on WLHIV aged 20 to 40 who resided at the informal settlement and were enrolled in the Central Chronic Medicine Dispensing and Distribution (CCMDD) program at the local clinic. Purposive sampling was used to select participants with relevant characteristics according to the inclusion and exclusion criteria outlined in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInclusion criteria\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eExclusion criteria\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026bull; Participants had to be WLHIV aged between 20 and 40 years.\u003c/p\u003e\u003cp\u003e\u0026bull; Participants had to have been living with HIV for over 5 years. To confirm this, the researcher asked confirmation questions like, \"How long have you been living with HIV?\"\u003c/p\u003e\u003cp\u003e\u0026bull; The participants had to be residents of the selected informal settlement.\u003c/p\u003e\u003cp\u003e\u0026bull; The participants had to be part of the CCMDD program at the local clinic\u003c/p\u003e\u003cp\u003e\u0026bull; Participants had to be able to speak English, Xitsonga, Tshivenda, Sepedi, or Isizulu. The researcher is fluent in all of these languages.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026bull; Women aged 20 to 40 years who were not living with HIV.\u003c/p\u003e\u003cp\u003e\u0026bull; WLHIV who were below 20 years or above 40 years of age.\u003c/p\u003e\u003cp\u003e\u0026bull; WLHIV who met the criteria but did not live at the selected informal settlement.\u003c/p\u003e\u003cp\u003e\u0026bull; WLHIV who met the criteria but were not enrolled in the CCMDD program at the local clinic.\u003c/p\u003e\u003cp\u003e\u0026bull; WLHIV who met the criteria but did not speak English, Xitsonga, Tshivenda, Sepedi, or Isizulu.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Ethical considerations\u003c/h2\u003e\u003cp\u003e Before the study began, ethical clearance was obtained from the Institutional Research Ethics Committee, number # Rec-240816-052. Approval was then granted by the local council to access the informal settlement. Subsequently, permission was sought from the Department of Health in Gauteng to sample participants from their health facility and to request assistance from the decanting facilitator for participant recruitment, both of which were approved. Ethical clearance was obtained from the relevant institutional ethics committee and the authorities. Key ethical principles adhered to included informed consent, confidentiality, anonymity, beneficence, debriefing, and avoidance of harm [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Data collection\u003c/h2\u003e\u003cp\u003e Recruitment was facilitated through the local clinic decanting team, who introduced the study during the CCMDD sessions. All participants provided written informed consent. Data was collected through semi-structured, face-to-face interviews guided by an interview guide. This approach ensured consistency while allowing participants to elaborate on their experiences and challenges [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Fifteen participants were interviewed, each choosing a convenient location for their one-on-one interviews to ensure confidentiality. Most participants preferred to be interviewed in their homes, as they found it more private and secure. Each interview lasted 45\u0026ndash;60 minutes, and to protect participants' privacy, numbers were used to refer to them [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. All interviews were audio-recorded with consent and transcribed verbatim. A pilot study involving three participants who met the inclusion criteria was conducted to test the clarity and relevance of the interview guide [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Minor adjustments were made, and pilot data were excluded from the final analysis and report. COVID-19 protocols were followed throughout the study. Data saturation determined the final sample size, with recruitment ceasing when no new themes emerged [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].The following research question guided the interviews:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cem\u003eWhat are the lived experiences of women living with HIV in coping with an HIV-positive diagnosis?\u003c/em\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e2.5 Data analysis\u003c/h2\u003e\u003cp\u003eThis study followed Tesch\u0026rsquo;s method of qualitative data analysis by Creswell [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. This process involved reading all transcripts for a general sense of the data, identifying significant statements, developing codes, grouping codes into themes and subthemes, and refining these to ensure they accurately reflected the participants\u0026rsquo; accounts.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e\u003ch2\u003e2.6 Data verification\u003c/h2\u003e\u003cp\u003eTrustworthiness was ensured using Lincoln and Guba\u0026rsquo;s (1986) framework of credibility, transferability, dependability and confirmability [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Credibility was strengthened through member checking, and detailed descriptions of the research context enhanced transferability. Dependability and confirmability were supported by maintaining an audit trail documenting each stage of the research process.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cp\u003eIn this section, we present the findings of our study, along with an analysis and discussion of the results. Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides an overview of the participants\u0026rsquo; biographical backgrounds, which is essential for understanding the context and diversity of the sample. This background information will help elucidate the subsequent findings and discussions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eParticipant Biographic Background\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eParticipants\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eEthnic group\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePeriod Living with HIV\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ePart of CCMDD\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVenda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eZulu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePedi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVenda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTsonga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTsonga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eZulu\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTsonga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTsonga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eVenda\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePedi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePedi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTsonga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePedi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTsonga\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e provides details about the study participants, who were assigned numbers for confidentiality purposes. The study involved fifteen WLHIV from an informal settlement in Gauteng, South Africa. Although twenty-five interviews were planned, data saturation was achieved with fifteen participants aged 27\u0026ndash;40 years, with none withdrawing after consenting. This age range is known for greater life stability and health awareness, which aligns with findings that women in their late 20s to 40s are more motivated to contribute to community health [\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. All participants had been living with HIV for at least five years (5\u0026ndash;19 years), which was associated with improved self-management and resilience [\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e] and were enrolled in the CCMDD program. All participants were Black African residents from four dominant ethnic groups: Vatsonga (n\u0026thinsp;=\u0026thinsp;6), Bapedi (n\u0026thinsp;=\u0026thinsp;4), Vhavenda (n\u0026thinsp;=\u0026thinsp;3), and Zulu (n\u0026thinsp;=\u0026thinsp;2), reflecting the area's demographic profile (Marutlulle, 2017). Interviews were conducted in their preferred language, primarily Xitsonga.\u003c/p\u003e\u003cp\u003eThe following Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e summarises the two main themes and six subthemes identified in the analysis.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThemes and sub-themes\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTHEMES\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSUB-THEMES\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme 1: Life after testing HIV-positive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-theme 1.1: Denial of one\u0026rsquo;s HIV status,\u003c/p\u003e\u003cp\u003eSub-theme 1.2: Blaming others\u003c/p\u003e\u003cp\u003eSub-theme 1.3: Lifestyle re-adjustment\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTheme 2: Challenges faced by women living with HIV\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSub-theme 2.1: Stigmatisation and rejection\u003c/p\u003e\u003cp\u003eSub-theme 2.2: Trust deficit among WLHIV\u003c/p\u003e\u003cp\u003eSub-theme 2.3: Financial difficulties.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 1: Life after testing HIV-positive\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis theme explores the journeys and experiences of women who tested positive for HIV. It delves into the emotional, social, and health-related challenges they face, as well as the personal growth and resilience that can emerge from such a life-altering diagnosis. It highlights the importance of support systems, access to medical care, and ongoing conversations about living well with HIV.\u003c/p\u003e\u003cp\u003eThe following subthemes were identified as common reactions derived from the findings:\u003c/p\u003e\u003cp\u003e\u003cb\u003eSub-theme 1.1: Denial of one\u0026rsquo;s HIV status\u003c/b\u003e\u003c/p\u003e\u003cp\u003e The study findings revealed that prior to acceptance, participants commonly experienced denial upon discovering their HIV-positive status. As one participant stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Well, my life has not changed much; the only difficulty I had was in the beginning because I was frightened. It took me a little longer to accept that I am HIV positive.\u0026rdquo;\u003c/em\u003e (P14).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSuch reactions are not unusual, as individuals rarely anticipate contracting HIV until after diagnosis. Denial serves as a psychological defence mechanism that shields individuals from overwhelming fear and distress [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. However, while some confront denial quickly, others remain trapped in it, delaying treatment initiation. Denial is a protective barrier against difficult realities, despite medical advances and wider societal acceptance of HIV [\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eLifestyle perceptions also emerged as factors influencing denial. Some participants measured their likelihood of infection against their personal choices, often ignoring the risks posed by their partners. This dissonance between perceived low-risk behaviour and an HIV-positive diagnosis fosters denial as a means of preserving self-image [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;It was very difficult for me to accept because I knew that things like HIV are far from me because of my lifestyle. I have one boyfriend, so I kept asking myself what happened. It was very difficult for me.\u0026rdquo;\u003c/em\u003e (P8).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDenial also reflects deeper psychological struggles, including fear of stigma, shame, and uncertainty about the future [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. For many, rejecting the diagnosis is a way to maintain control and avoid confronting mortality [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Cognitive dissonance, the conflict between prior beliefs and the imposed reality of diagnosis, further intensifies reliance on denial as a coping mechanism [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eSub-theme 1.2: Blaming others\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study findings indicate that many participants struggled to take responsibility or demonstrate accountability after receiving positive HIV test results. Men were often identified as central to HIV transmission; however, support from partners also emerged as a source of hope. Anger was a dominant theme, as one participant stated:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I was very angry from my past relationship because my then-boyfriend used to abuse me, learning that I am HIV positive fuelled the anger because I knew that I got it from him, because I have never cheated, but after attending church and counselling, I managed to deal with the anger and forgave him.\u0026rdquo;\u003c/em\u003e (P9)\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eParticipants frequently attributed their HIV status to others, a response shaped by the social stigma surrounding HIV [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Blaming others appeared to provide emotional relief, although it complicated the process of acceptance. Many described feeling victimised by their partners, as illustrated below:\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"I have accepted being HIV positive, but it has changed how I view men. I believe my ex-boyfriend infected me, and I separated from a supportive partner who was scared. Now, it's hard to find men who accept my status; they often disappear after I disclose it.\" (P13)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"I felt my life turn upside down when I discovered I had HIV. My husband, my high school boyfriend of 18 years, had cheated, and despite my love and loyalty, I never expected this outcome.\" (P11)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBlame is used as a coping mechanism to ease distress, fear, and guilt. It is initially served to protect self-esteem and provide a sense of control over time. The tendency to blame is further reinforced by the pervasive stigma attached to HIV, which remains associated with immorality [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Internalised stigma often heightens shame, while misconceptions about transmission contribute to perceptions of being infected through others\u0026rsquo; negligence or betrayal.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSub-theme 1.3: Lifestyle Re-adjustment\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study findings revealed that living with HIV necessitates significant lifestyle modifications, supporting the adage that change is a challenging process. Participants described adjustments ranging from dietary changes and treatment adherence to relationship losses when their partners could not sustain the relationship.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"Living with HIV does not stop me from chasing my dreams. At 29, I encourage other women to stick to their treatment and adopt a healthy lifestyle to boost their immune systems.\"\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHIV diagnosis often heightens stress levels, adversely affecting both physical and mental health [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e]. Effective stress management through mindfulness, yoga, or deep breathing is critical for immune system protection [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. Diet also plays a central role, with nutrient-rich foods and probiotics being vital for maintaining immune function [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. However, participants admitted to having initial knowledge gaps.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The only thing I knew was that HIV does not kill you when you take your medication consistently; However, I did not know about changing your whole lifestyle, adjusting food, and the possibility of being reinfected. I felt like I did not know anything.\u0026rdquo;\u003c/em\u003e (P2).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eSubstance abuse, including alcohol and drug use, has also been identified as a critical risk factor that compromises adherence and immune strength [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. For some, this required a profound shift in their behaviour.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\"I used to eat anything and drink alcohol while partying. However, after researching the impact on my health, I realised I needed to eat healthier and stop drinking. Consequently, I changed my lifestyle.\"(P4)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eBeyond nutrition and substance use, physical exercise is essential for quality of life. Studies have confirmed that regular activity enhances the immune response, alleviates HIV-related symptoms, and prevents secondary conditions associated with sedentary living [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e]. Strength training further supports muscle mass and bone density, whereas aerobic exercise improves cardiovascular fitness and mental well-being [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eTheme 2: Challenges faced by WLHIV\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study identified several primary challenges faced by WLHIV after testing positive for HIV. These include HIV-related stigmatisation and rejection, a trust deficit among WLHIV, and financial difficulties.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSub-theme 2.1: Stigmatisation and Rejection\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe findings of this study show that WLHIV frequently encounter various forms of social stigmatisation and rejection. Some participants experienced social isolation or were unwelcome within the larger community because of their HIV status. This stigmatisation and rejection are also experienced within their immediate circles, including family members, friends, and partners. As a result of the fear of facing stigmatisation and rejection, WLHIV expressed a preference for remaining single due to apprehension about potential rejection based on their HIV status.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, I think it is like any illness; the main difference is the constant awareness of it. For me, the hardest part has been dating, as I now have to disclose my condition. What if he rejects me?\u0026rdquo; (P2)\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003e\"One challenge I face as a woman living with HIV is starting new relationships. Disclosing my status is essential, but it\u0026rsquo;s still difficult. No matter how clearly I explain HIV, individuals often have their own views that may differ from mine.\"(P8)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eChanges in our lives can significantly impact us, leading to positive or negative outcomes. A prime example is discovering one's HIV status, which can evoke considerable fear and anxiety, particularly if the test result is positive [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e]. WLHIV continue to encounter significant challenges, particularly stigma and rejection [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This persists despite advancements in medical treatment and public health education [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Stigma manifests through discrimination, prejudice, and rejection, which can have serious psychosocial and health consequences for those affected by it [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The detrimental effects of such stigmatisation and rejection can lead to hesitancy in disclosing one's HIV-positive status to partners or family members because of fear of negative repercussions on their relationships. This fear of discrimination may deter WLHIV from seeking testing and treatment, resulting in delayed diagnosis and increased transmission rates [\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Furthermore, fear of societal judgment and rejection compels WLHIV to conceal their status, often leading to isolation and a lack of social support. Consequently, the absence of support and meaningful connections can adversely affect their mental, emotional, and physical health, contributing to higher rates of depression, anxiety, and substance abuse [\u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eSub-theme 2.2: A trust deficit among WLHIV\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study findings revealed that fear of stigmatisation and discrimination significantly contributed to the trust deficit experienced by WLHIV. Consequently, women often hesitate to trust men or disclose their HIV status because they fear abandonment, judgment or rejection. Participants described how these experiences eroded their abilities to form new relationships.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I struggled to trust men after what happened, and I even stopped dating for almost two years. Other challenges would be the same as everyone who is living with HIV Some people don\u0026rsquo;t know about HIV, so they discriminate against us and don\u0026rsquo;t want to be associated with that, but for me now, I have accepted.\u0026rdquo;\u003c/em\u003e (P7).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;I will say it is no longer easy for me to trust men, and it is also a challenge when men leave me after they learn my status. I am now single and happy; I don\u0026rsquo;t want any relationship because I fear that it won't last after they know my status and they start to stigmatise me.\u0026rdquo;\u003c/em\u003e (P9).\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eHarmful gender norms and stereotypes intensify stigma, producing negative societal attitudes and internalised feelings of shame [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Lack of trust following an HIV diagnosis carries severe psychological and emotional consequences. Trust, which ordinarily rests on loyalty, honesty and emotional support, is profoundly disrupted by fears of infidelity, non-disclosure, and blame [\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e]. Furthermore, unequal gender power dynamics worsen mistrust. Historically, women\u0026rsquo;s dependence on men for emotional and financial support has created such vulnerabilities [\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e]. An HIV diagnosis amplifies these imbalances and deepens feelings of betrayal. Many participants expressed distrust of men, viewing them as responsible for HIV transmission, which in turn contributed to relationship breakdowns and separations from their partners.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSub-them 2.3: Financial difficulties\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe study also found that financial hardships prevented some women from coping with their HIV diagnosis. Participants pointed out that expenses related to transportation to the clinic for medication collection and adherence to a prescribed diet were especially difficult, particularly for those who were unemployed. Consequently, this hinders their adherence to the treatment plan and their ability to attend clinic appointments as scheduled, which is contrary to the behaviour of someone aiming to be resilient to HIV.\u003cdiv class=\"BlockQuote\"\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, another challenge was the issue of food, as they say you need to eat specific food types, which I could not afford because I am unemployed. I rely on my boyfriend for money for taxi fares so I can go collect my medication\u0026rdquo;.\u003c/em\u003e (P4).\u003c/p\u003e\u003cp\u003e\u003cem\u003e\u0026ldquo;The biggest challenge I face is disclosing my status to men I'm interested in. Many pull away due to misconceptions about the disease, making it hard to find love. I'm also unemployed, so I struggle to afford clinic visits, though my family sometimes helps me with the costs.\u0026rdquo; (P9)\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAccording to the definition of resilience, a resilient person is someone who can use their resources to find solutions to the problems they face [\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e]. In this case, economic disparities played a crucial role in worsening the situation for WLHIV. Women often have less economic independence and face more financial obstacles, especially in developing countries [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. This economic disadvantage limits their ability to access necessary healthcare and to follow treatment plans [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. Additionally, the lack of economic resources increases their vulnerability to other health challenges, such as malnutrition and poor mental well-being, which further amplifies the impact of HIV on women's overall health [\u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e]. The financial difficulties that WLHIV experience are one of the contributing factors to the majority of WLHIV failing to cope with their HIV diagnosis.\u003c/p\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThis study explored the lived experiences of women living with HIV following their diagnosis, revealing a complex journey marked by significant psychological distress, social challenges, and adaptation. These findings align with and extend the existing literature on HIV, highlighting that a positive diagnosis remains a profoundly life-altering event that necessitates considerable psychological and lifestyle adjustments, even in the era of effective antiretroviral therapy.\u003c/p\u003e\u003cp\u003eThe initial reaction of denial emerged as a critical first response to an HIV-positive diagnosis. This finding is consistent with established psychological models of grief and loss, wherein denial functions as a protective mechanism against overwhelming information [\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e]. The participants' narratives, such as measuring their perceived low-risk lifestyle against the reality of their diagnosis, exemplified cognitive dissonance. This dissonance between self-perception and a stigmatised illness can foster denial as individuals struggle to integrate the new, threatening identity of being a person living with HIV into their existing self-concept [\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e]. However, prolonged denial poses a significant barrier to engaging in care. Recent research underscores that rapid ART initiation is crucial for both individual health and prevention efforts, making the timely transition from denial to acceptance a critical public health objective [\u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eClosely linked to denial was the tendency to blame others, particularly male partners, for HIV transmission. This coping strategy can be understood as an attempt to manage intense emotions, such as anger, shame, and a perceived loss of control. While blame may offer temporary emotional relief, it can complicate long-term acceptance and trust in future relationships. This finding is closely intertwined with gendered power dynamics; in many contexts, HIV stigma is heavily gendered and associated with moral judgments about sexuality [\u003cspan citationid=\"CR69\" class=\"CitationRef\"\u003e69\u003c/span\u003e]. Women often bear a disproportionate burden of this stigma, and blaming a partner can be a way to deflect this perceived immorality and preserve their self-esteem. Furthermore, scholars continue to highlight that intimate partner violence and gender inequality are significant drivers of HIV risk for women and barriers to disclosure and care post-diagnosis [\u003cspan citationid=\"CR70\" class=\"CitationRef\"\u003e70\u003c/span\u003e, \u003cspan citationid=\"CR71\" class=\"CitationRef\"\u003e71\u003c/span\u003e], providing a contextual backdrop for the anger and blame expressed by participants.\u003c/p\u003e\u003cp\u003eA cornerstone of living well with HIV is lifestyle re-adjustment. Participants described comprehensive changes, including dietary improvements, substance use cessation, and exercise, which are well documented to support immune function and overall quality of life [\u003cspan citationid=\"CR72\" class=\"CitationRef\"\u003e72\u003c/span\u003e, \u003cspan citationid=\"CR73\" class=\"CitationRef\"\u003e73\u003c/span\u003e]. However, the initial lack of knowledge reported by participants points to a potential gap in post-test counselling services. Moving beyond basic ART adherence education to include holistic nutritional, mental health, and physical activity guidance is increasingly recognised as the best practice in HIV care [\u003cspan citationid=\"CR74\" class=\"CitationRef\"\u003e74\u003c/span\u003e]. The journey from initial ignorance to empowered self-management, as described by some participants, illustrates the development of health literacy as a key component of resilience and long-term health outcomes for WLHIV.\u003c/p\u003e\u003cp\u003eThe challenges of stigmatisation and rejection remain formidable barriers, corroborating global research that, despite medical advances, social attitudes have not progressed at the same pace [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The fear of rejection led many participants to withdraw from dating or anticipate relationship dissolution upon disclosure of their status. This internalised and anticipated stigma can be as damaging as enacted stigma, leading to social isolation, poor mental health, and deterring individuals from accessing care to keep their status secret [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. A recent study by Inglis confirmed that harmful gender norms continue to intensify this stigma, creating an environment where WLHIV are unfairly judged [\u003cspan citationid=\"CR75\" class=\"CitationRef\"\u003e75\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThis pervasive stigma directly fuels trust deficits, particularly towards men and potential new partners. The erosion of trust described by the participants disrupts a fundamental element of human connection and social support. As some scholars argue, trust is built on honesty and emotional safety, which are shattered by experiences of betrayal and fear of rejection [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR76\" class=\"CitationRef\"\u003e76\u003c/span\u003e]. This finding is critical because social support is a well-established predictor of ART adherence and mental well-being. Without interventions to rebuild trust and foster supportive partnerships, WLHIV may remain isolated, negatively impacting their health.\u003c/p\u003e\u003cp\u003eFinally, the theme of financial difficulty underscores the stark intersection between health and socioeconomic status. The participants' struggles with the costs of transport and nutritious food highlight how poverty is a primary barrier to resilience. For one to be resilient to HIV, they require access to resources to overcome such adversity [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. For WLHIV, economic vulnerability can directly undermine clinical outcomes by hindering clinic attendance and the ability to maintain a healthy lifestyle [\u003cspan citationid=\"CR77\" class=\"CitationRef\"\u003e77\u003c/span\u003e]. This is exacerbated by the fact that women, particularly in certain regions, often have less economic independence [\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e]. Recent economic shocks, such as the COVID-19 pandemic, have further exposed and deepened these health inequities, disproportionately affecting the care continuum for WLHIV [\u003cspan citationid=\"CR78\" class=\"CitationRef\"\u003e78\u003c/span\u003e].\u003c/p\u003e"},{"header":"5 Conclusion","content":"\u003cp\u003eIn conclusion, the journey after an HIV-positive diagnosis for the women in this study is a testament to the ongoing interplay between biomedical, psychological, and social factors. While ART has transformed HIV into a manageable chronic condition, the lived experience is still shaped by stigma, gender inequality, and economic hardship.\u003c/p\u003e\u003cp\u003eThese findings have several implications:\u003c/p\u003e\u003cp\u003e\u003col\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eClinical Practice: Post-test counselling and ongoing care must move beyond biological management to address psychological reactions (e.g., denial and blame) and provide concrete, holistic education on lifestyle adjustments.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eMental Health Support: Integrated mental health services are essential for helping individuals process trauma, anger, and distrust and develop healthy coping strategies to mitigate isolation.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eStigma Reduction: Public health campaigns must evolve to address the persistent, gendered nature of HIV stigma and promote messages that normalise living with HIV.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003cspan\u003e\u003cli\u003e\u003cp\u003eStructural Interventions: Policy efforts must address the structural barriers, particularly poverty and gender inequality, that underpin many of these challenges. This could include supporting programs that provide nutritional support, transport vouchers, and economic empowerment opportunities for WLHIV.\u003c/p\u003e\u003c/li\u003e\u003c/span\u003e\u003c/ol\u003e\u003c/p\u003e\u003cp\u003eAlthough this study was limited by its focus on a specific population, it provides rich insights into the experiences and challenges of WLHIV. Future research should broaden the scope to include more diverse participants and explore the long-term outcomes of trust deficits, stigma, and economic disparities. In the South African context, where structural inequalities remain entrenched, addressing these challenges is not only a matter of health but also of social equity. Future research should continue to explore interventions that effectively build resilience, foster social support, and empower WLHIV to navigate these complex challenges and lead healthy and fulfilling lives.\u003c/p\u003e\u003cp\u003eThese experiences are not isolated but are deeply embedded within gendered power dynamics, societal attitudes, and structural inequalities that continue to marginalise WLHIV. The erosion of trust, both in intimate relationships and in wider social networks, was particularly damaging, as it heightened feelings of isolation, rejection, and vulnerability to depression and anxiety. Moreover, financial difficulties were shown to be a major barrier, limiting access to healthcare, adherence to treatment, and the ability to live healthily. Collectively, these findings underscore the need for a holistic response that goes beyond medical treatment to include psychosocial support, economic empowerment, and stigma reduction interventions.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConflict of interest\u003c/h2\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003ch2\u003e\u003cstrong\u003eConsent to Participate\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003edeclaration\u003c/strong\u003e\u003c/h2\u003e\n\u003cp\u003eAll participants provided written informed consent.\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eEthical approval\u003c/h2\u003e\n\u003cp\u003eThe study was approved by the University of South Africa Research Ethics Committee, Ref number: # Rec-240816-052. Approval was then granted by the local council to access the informal settlement. Subsequently, permission was sought from the Department of Health in Gauteng, South Africa.\u003c/p\u003e\n\u003ch2\u003eClinical trial number\u003c/h2\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThis study was not funded by any external sources; it was self-funded.\u003c/p\u003e\n\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\n\u003cp\u003eThe TM participated in the conception, design, data collection, data analysis, and drafting of the initial manuscript. The RM supervised the research and critically reviewed the manuscript. All authors approved the final version of the manuscript.\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eWe express our gratitude to all the WLHIV who participated in this research, the Gauteng Department of Health, and the local councillor of the informal settlement for permitting us to conduct the study in their health facility and community. We also thank the officials at the health facility who assisted in identifying the study\u0026rsquo;s participants.\u003c/p\u003e\n\u003ch2\u003eData Availability\u003c/h2\u003e\n\u003cp\u003eAll relevant data are included in the article. However, more information is available upon reasonable request from the corresponding author.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSwinkels H, Nguyen A, Gulick P. HIV and AIDS. StatPearls. 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMannell J, Willan S, Shahmanesh M, Seeley J, Sherr L, Gibbs A. Why interventions to prevent intimate partner violence and HIV have failed young women in southern Africa. J Int AIDS Soc. 2019;22(8):e25380.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHemelaar J, Elangovan R, Yun J, Dickson-Tetteh L, Kirtley S, Gouws-Williams E, et al. 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South Afr Family Pract. 2023;65(1):5660.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eOrton PM, Sokhela DG, Nokes KM, Perazzo JD, Webel AR. Factors related to functional exercise capacity amongst people with HIV in Durban, South Africa. Health SA Gesondheid (Online). 2021;26:1\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaggers JR, Hand GA. Health benefits of exercise for people living with HIV: A review of the literature. Am J Lifestyle Med. 2016;10(3):184\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRobinson A, Cooney A, Fassbender C, McGovern DP. Examining the Relationship Between HIV-Related Stigma and the Health and Wellbeing of Children and Adolescents Living with HIV: A Systematic Review. AIDS Behav. 2023;27(9):3133\u0026ndash;49.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMahlalela NB, Manne-Goehler J, Ohene-Kwofie D, Adams B, Montana L, Kahn L. 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Rebuilding Trust After Betrayal: A Roadmap for Couples and Individuals. Jstone Publishing; 2024.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasevhege MT, Jane MW. Determinants of Antiretroviral Treatment Default in People Living with HIV at a Community Health Centre in Northwest Province, South Africa.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePinto RM, Park S. COVID-19 Pandemic Disrupts HIV Continuum of Care and Prevention: Implications for Research and Practice Concerning Community-Based Organisations and Frontline Providers. AIDS Behav. 2020;24(9):2486\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-social-science-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diss","sideBox":"Learn more about [Discover Social Science and Health](https://www.springer.com/journal/44155)","snPcode":"","submissionUrl":"","title":"Discover Social Science and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Women, Lived experiences, HIV, Living with HIV, HIV positive diagnosis, Stigma","lastPublishedDoi":"10.21203/rs.3.rs-7538508/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7538508/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eGlobally, over 37 million individuals are infected with HIV, with women disproportionately affected. Women living with HIV (WLHIV) account for about 53% of all people living with HIV (PLHIV). This is due to factors like gender-based violence, stigma, socio-economic challenges, low economic status and gender disparities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study explored the unheard lived experiences of WLHIV in coping with an HIV-positive diagnosis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study utilised a qualitative phenomenological design with 15 women living with HIV (WLHIV) from the Central Chronic Medication Dispensing and Distribution Programme (CCMDD) at the Winnie Mandela Clinic in Ekurhuleni, Gauteng Province, South Africa. Data was collected through semi-structured interviews and analysed using Tesch's approach, resulting in two main themes and six subthemes. The study ensured data accuracy and reliability through trustworthiness measures and adhered to ethical considerations throughout the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study found that women living with HIV (WLHIV) face various challenges, including denial of their HIV status, blame, and lifestyle changes. Key difficulties include stigma, rejection, trust issues, and financial hardships. These negative influences can lead to poor treatment adherence and an increased risk of HIV-related deaths.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions and implications\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe contributions of this study will be diverse, providing significant benefits to academic, policy, and clinical fields. It is anticipated that the findings will assist in creating social work and public health interventions to support individuals facing these challenges and empower newly diagnosed women with HIV by equipping them with the skills to navigate these difficult experiences.\u003c/p\u003e","manuscriptTitle":"Beyond an HIV Diagnosis: The Unheard Lived Experiences of Women Living with HIV in Gauteng Province, South Africa","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-29 14:41:58","doi":"10.21203/rs.3.rs-7538508/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-10-16T11:54:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-06T16:42:14+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-10-05T07:01:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"129421883189114045665643186940194333989","date":"2025-09-29T10:57:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"109589157791487247734086651523877473276","date":"2025-09-26T06:59:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"211728550928135283851913313035208991227","date":"2025-09-20T10:03:53+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-18T09:41:46+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-11T16:03:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-11T09:05:56+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-11T09:05:13+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Social Science and Health","date":"2025-09-04T18:00:56+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-social-science-and-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"diss","sideBox":"Learn more about [Discover Social Science and Health](https://www.springer.com/journal/44155)","snPcode":"","submissionUrl":"","title":"Discover Social Science and Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f28f5c9d-bfd7-47e8-8e43-a9207df68db2","owner":[],"postedDate":"September 29th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-01-20T15:23:21+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-29 14:41:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7538508","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7538508","identity":"rs-7538508","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}