Objective(s): To describe stigma among seropositive MSM, female sex workers (FSWs), and Haitian-descent individuals in the Dominican Republic, and to assess whether stigma is associated with HIV treatment outcomes. Design: Cross-sectional survey using Stigma Index 2.0. Methods: People living with HIV (PLHIV) interviewed seropositive adult MSM, FSWs, Haitian-descent persons, and other PLHIV who did not identify with these communities about experiences of social exclusion, harassment, stigma in healthcare settings, and internalized stigma. Bivariate analyses were conducted to compare experiences between FSWs and other women; MSM and other men; and Haitian-descent participants and non-Haitian PLHIV. Within each community, separate multivariate logistic regression analyses were conducted to examine the association between stigma experiences with viral suppression and with missed antiretroviral doses. Results: The 891 participants consisted of 154 MSM, 216 FSWs, 90 Haitian-descent persons, and 447 who did not identify with any of these three communities. Compared with other women, FSWs reported significantly higher levels of harassment due to their HIV status, and those of Haitian descent reported significantly lower levels of social exclusion compared with non-Haitian PLHIV. In adjusted analyses, MSM who experienced more stigma in HIV-specific services had a significantly lower odds of knowing they had undetectable viral load (adjusted odds ratio 0.37, P < 0.05). Higher internalized stigma scores were significantly associated with missing an antiretroviral treatment dose among FSWs (adjusted odds ratio 1.26, P < 0.05). Conclusion: For FSWs and MSM, efforts to mitigate HIV-related stigma are necessary to improve treatment adherence and viral suppression. For Haitian-descent PLHIV, interventions must address not only their HIV-specific needs, but also the broader social and legal barriers to care.

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A recent article in GHSP calls for classifying fertility awareness methods as “modern contraceptives” despite their inferiority. We believe in a rights-based approach, which considers the real-world conditions that many women face, including constrained sexual agency and low baseline reproductive health literacy. We must demonstrate true commitment to increasing access to the most effective and reliable contraceptive methods.

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Program participants have been largely excluded as an evidence source in realist evaluations. We test whether and how lived experience as described through life history interviews with pilot program participants can be used as a valid and unique source of data for elucidating context (C)–mechanism (M)–outcome (O) configurations and informing program theory. We use data about “Opening Opportunities,” a program for indigenous adolescent girls in rural Guatemala, to build a theory of change relating to educational attainment. Life histories yield a rich data set that allows probing of quintessential realist questions; capture subtle, hard-to-measure, and longer term contextual factors and mechanisms; elucidate co-occurring CM and MO dyads; help decipher individual- and structural-level contexts; and provide unique additions and refinements to the program theory. Importantly, this work expands potential evidence sources to inform program theory by including the unique insights from those with lived experience.