When Stigma Differs: A Cross-Sectional Study of Divergent Associations of Internalized and Enacted Stigma on Human Immunodeficiency Virus Disclosure in Zambia.

Background: In Zambia, HIV is a serious public health concern that predominantly affects women of reproductive age. Disclosure of HIV status remains central to treatment adherence, partner notification, and prevention efforts. Yet stigma continues to constrain disclosure. However, the question remains that: are all stigma the same? How different does internalized and enacted stigma affect HIV status disclosure? To answer these questions, the study examined the association between internalized, enacted stigma, and HIV status disclosure among women in Zambia. Methods: This study analyzed the 2024 demographic and health survey data of 1037 women living with HIV in Zambia. The outcome variable was HIV status disclosure, with the key exposure variables being internalized and enacted stigma. A multivariable logistic regression was performed to assess the association. Statistical significance was set at Results: Overall, 89.7% (95% CI: 87.5-91.5) of women reported having disclosed their HIV status. About 26.1% and 21.8% experienced internalized and enacted stigma, respectively. The findings also revealed that women living with HIV mostly disclosed their status to family members (48.2%), followed by their intimate partners (29.7%). Women who experienced internalized stigma had significantly lower odds of HIV disclosure [AOR = 0.52; 95% CI: 0.33-0.84]. However, enacted stigma showed no statistical significance. Conclusion: HIV disclosure among women in Zambia is high but remains patterned by internalized stigma and HIV transmission knowledge. Integrating stigma-informed counseling with targeted health education may enhance disclosure and support broader HIV prevention and care outcomes.