Table 4 Themes with illustrative quotes

Intersectional stigma of HIV and domestic violence amplifies stigma as a whole

HIV stigma triggers domestic violence

“There was a lot of trouble, lot of trouble [after diagnosis] …if one person quarrels and moves away, then another comes to quarrel, then after that one moves away, another one comes to quarrel. I had to run away to my mother’s house at night… there was trouble and quarrels… ‘where did you get it from, tell us who you had a relationship with’…” (Participant 019)

Perpetrators reinforce stigma through abuse

What I have seen in the case of family violence, the projection that is there, ‘I got it from you’, … ‘you must have a relationship with someone, with whom you had sex, for which reason you have become positive, for which reason I have become positive’…then she has to face more abuse…I mean that reaches the level of physical assault (Clinical psychologist)

HIV stigma worsens domestic violence stigma

“Yeah… if they have already been there …been experiencing, …domestic violence, and, yeah, there is no safe space…for them to talk. And similarly, … if they are diagnosed with HIV also, like it’s a kind of a … double stigma … for women. And they don’t talk about that [domestic violence] openly… even among women living with HIV, they don’t talk about domestic violence, you know. They only talk about HIV, that status, but often they don’t talk about the domestic violence part” (HIV Activist)

The intersection of multiple stigma worsen domestic violence

The intersection of HIV and widowhood stigma

“…When my husband died then they said that she walks on the bad road, that’s why she has this [HIV]…when I came to see the doctor here they said people thought I was really going somewhere else. When I came to see the doctor here I would not tell anyone” (Participant 014)

The intersection of HIV, widowhood, and girl child stigma

“My father-in-law and mother-in-law… they threw me out… She [the widow] will live [in a corridor] by the entrance [to the house] with a [girl] child but they [neighbours] did not do anything… I stayed by the entrance for 6 months” (Participant 030)

The intersection of HIV and sex work stigma

“…women are really neglected…because these are mostly trafficked women [sex workers] … maybe because of that the family rejects them more. A lot of families don’t want to take them back because she has been rescued in that way [from the sex trade]… ‘if we take her back our honor will be lost’. If they hear HIV positive then even more honor will be lost” (Counselor)

The double burden of HIV and gender identity stigma

“…a transgender person is constantly stigmatized because of their gender. They are bullied…and when she is infected with HIV, then her stigma becomes a double stigma” (Public health official)

The intersection of HIV and perceived poverty stigma

“Bigger [problem if people find out HIV status] for the poor. Because the rich will use their money to adjust it. It is a bigger problem for the poor. Problem from all sides. Living is very painful.” (Participant 023)

Stigma of HIV hides domestic violence

Women unable to share experiences of violence with others

“If he causes problems [violence] then I feel like the problems are crushing me from within…I sit alone quietly by that window… I stay quiet, don’t tell anyone. When there are problems within, I stay quiet at times and at times I [want to] let them [others] know that I have such problems. Then I think, ‘what’s the point in telling?’” (Participant 007)

HIV stigma a barrier to help-seeking from informal sources

“No, [a woman] can’t [ask for her help for domestic violence]. No, she can’t, she can’t…she has HIV, the neighbors know, the fault will lie with the woman, it will be the woman’s fault. And everyone has ghenna towards this disease” (Participant 013)

Perception of reduced support from formal sources

“Rather than help [after an episode of domestic violence] I think they [village representative] would have more ghenna towards me. More people would get to know than the few people who knew… That’s why I didn’t say these things. I just told them about the trouble [violence] but I didn’t tell them very much more” (Participant 19)