Stigma, Discrimination, and Bias Toward Patients with HIV

Peter grew up in a suburban neighborhood with a caring family that struggled financially. He was an average student who loved playing baseball and had a steady girlfriend named Jamie. At the age of 17, his mother developed breast cancer, and to help the family out, he quit sports and began working a part-time job after school and on weekends. He began to experiment with drugs as a coping mechanism for grief and stress. His experimentation began with snorting methamphetamine and advanced to sharing needles with his friend from work, Terrance.

On Saturday night, two days before Peter's 18th birthday, he and his friend used the same syringe to inject methamphetamine. At the time, neither of them knew about the risks of sharing needles. A few months later, Terrance became very ill. He started having unexplained weight loss, fevers, and swollen lymph nodes. Terrance went to his primary care provider's office, thinking he might have a simple case of mononucleosis. The primary care provider discussed the risks of HIV infection with Terrance and ordered a combination of serology assays for the detection of antibodies to HIV and the HIV antigen (WHO, 2024). Terrance's tests came back positive for HIV. In a panic, Peter got tested and was initially found not to have detectable HIV antibodies. His provider recommended that he be retested again in six months.

Peter returned to his primary care provider at the six-month mark and was tested again following the AIDS Education & Training Center (2022) guidelines with baseline labs, which included HIV antigens and antibodies (Ag/Ab), HIV ribonucleic acid (RNA), estimated creatinine clearance (eCrCl), and a lipid panel. He also received sexually transmitted infection (STI) testing, including gonorrhea/chlamydia (throat, rectum, and genital/urine screening according to sites of exposure), syphilis, hepatitis B (HBV) Ag/Ab, hepatitis C (HCV) Ab, and hepatitis A immunoglobulin G (IgG). His healthcare provider reviewed Peter's immunization status and made sure he was current on all his immunizations.

Peter shared that he had broken up with his girlfriend, Jamie, because he was afraid he might give her HIV through kissing and having unprotected sex. Peter also shared that he was having suicidal thoughts since being exposed to HIV.

His healthcare provider questioned Peter further about his depression and suicidal ideation. Peter told the provider that he had quit playing baseball because his mom was sick with breast cancer and had taken a job to help support the family. He felt like he had lost his childhood with all the stress, and with the recent worries about HIV, he was not coping well. He had started having more crying spells and loss of appetite and was not sleeping more than 5-6 hours a night. The provider administered a Patient Health Questionnaire-9 (PHQ-9) test, and Peter's depression score was severe, with a score of 20.

The provider discussed getting Peter into counseling for cognitive behavioral therapy as well as starting a selective serotonin reuptake inhibitor (SSRI) for the treatment of depression. She also reviewed with Peter important information on the transmission of HIV. She shared that HIV is primarily spread through blood, semen, vaginal fluids, rectal fluids, and breast milk. It cannot be transmitted through saliva, tears, sweat, casual contact, or sharing food or drinks. This meant that kissing posed little risk unless both partners had open sores or bleeding gums.

The healthcare provider educated Peter that unprotected sex increases the risk of HIV transmission, but using condoms consistently and correctly can significantly reduce this risk. Additionally, medications such as pre-exposure prophylaxis (PreP) and post-exposure prophylaxis (PEP) can help prevent transmission if taken appropriately. The provider thanked Peter for being open and honest about his feelings so that she could provide him with the highest quality of care possible. They further discussed that sharing needles was the point of risk for Peter's initial potential exposure, and she cautioned him against this behavior in the future.

Peter's test results came back positive for HIV this time. He went into therapy to help him develop better coping mechanisms for stress, anxiety, and grief. He started an SSRI to help with his depressive symptoms, as well as started ART to keep his viral load low. Peter was committed to his treatment regimen, trusted his medical providers, and was able to maintain his medication dosing schedule. Peter learned as much as he could about HIV and, with the support of his medical team, family, and friends, eventually became a peer advocate for other adolescents who were living with HIV.

The HIV virus can be found in most body fluids, including urine, semen, cerebrospinal fluid, blood, tears, amniotic fluid, saliva, breast milk, and vaginal secretions; however, the spread of the virus occurs primarily through contaminated blood, breast milk, semen, and vaginal sections (HIV.gov, 2025c; Patel et al., 2014; Wyzgowski et al., 2016). In the United States, HIV is spread primarily through infected blood and body fluid via anal or vaginal sex or sharing needles and syringes with an HIV-positive partner (HIV.gov, 2025c; Wyzgowski et al., 2016). The highest risk behavior is anal sex, meaning that gay, bisexual men are the population most at risk for HIV infection. By race, Black, African Americans, and Hispanic/Latino populations are disproportionately affected by HIV compared to other racial and ethnic groups in the United States. People who inject drugs remain at high risk as well (CDC, 2025a; CDC, 2025b; HIV.gov, 2025c).

HIV is a Lentivirus that belongs to a group of retroviruses. There are two variants of this virus, HIV1 and HIV2, which occur primarily in West Africa (Ibe et al., 2010; Wyzgowski et al., 2016). The reverse transcriptase enzyme, in which the retroviruses are equipped, enables them to transcribe their own RNA into deoxyribonucleic acid (DNA) and then merge them into the host cell genome. HIV attacks the cells containing antigens CD4 (T-helper lymphocytes and macrophages) on their surface and then destroys them, which leads to immunodeficiency, increased incidence of opportunistic infections, and malignancies (Parthasarathy & Ravishankar, 2007; Wyzgowski et al., 2016). Since research supports the theory that HIV is most readily transmitted via infected blood products, the risk to the healthcare workforce is greatest while working with blood (e.g., starting IVs, cleaning wounds, etc.) (Wzgowski, 2016).Standard precaution protocols remain the gold standard for the prevention of disease transmission in a healthcare setting (CDC, 2024a). This includes performing hand hygiene, using personal protective equipment (PPE) when appropriate, following respiratory hygiene/cough etiquette principles, properly cleaning and disinfecting patient care equipment and instruments or devices, and following safe injection practices (CDC, 2024a).

Although there is no cure for HIV, there is a treatment that can reduce the viral load in the body to the point that it is undetectable, which also prevents transmission to others (CDC, 2024c). This treatment is called ART. There are two forms of treatment currently available: pills and injectables. According to the World Health Organization (WHO) (2024), ART should be started immediately after being diagnosed with HIV as it reduces comorbid disease, transmission rates, and the risk for disease progression. Primary options for treatment include the combination drug bictegravir/emtricitabine/tenofovir alafenamide. It can be used both for HIV infection as well as PEP (off-label) but is only available for adults over the age of 18. It is a once-daily dosing (Gilead Sciences, 2024). Another primary option is dolutegravir/lamivudine, which is another pill form that is only indicated for adult use. It also is a once-a-day dosing (VIIV Healthcare, 2024). If a healthcare provider is exposed to HIV by needlestick or blood splash, antiviral drugs should be taken a maximum of 72 hours after exposure and for at least four weeks (CDC, 2024c).

In 2021, the first long-acting injectable ART option for individuals with HIV became Food and Drug Administration (FDA)-approved (Binkley, Zimmerman & Maguire, 2024). This new medication expanded treatment options for clients who struggled with adhering to daily oral medication or had multidrug-resistant HIV. Since then, two additional antiretroviral injectables have come to be marked with FDA approval (Brinkley, Zimmerman & Maguire, 2024).

Cabotegravir/rilpivirine long-acting injectable (CAB/RPV LA) has two dosing regimens: a 4-week regimen and an 8-week regimen. Doses can be administered within seven days prior to or after the target injection date. Lenacapavir (LEN) was approved in 2022, working at multiple stages of the HIV virus life cycle to disrupt the replication (Binkley, Zimmerman & Maguire, 2024). There are many other drugs on the market that are available and FDA-approved for HIV treatment. They can be found at HIV.gov.

Everyone who has HIV should take HIV treatment regardless of how long they have had the disease or how healthy they currently are at this time. Left untreated, HIV will continue to harm the immune system and increase the risk of transmission, getting sick, and developing AIDS. Before treatment, people with HIV need counseling to ensure readiness. Compliance with the medication regimen and attending regularly scheduled appointments are paramount to the efficacy of treatment. Clients need to understand how their medications work and why keeping a viral load low is essential to maintaining their overall health and quality of life. When the HIV load is elevated, the immune system is taxed, increasing the risks for opportunistic infections. Clients should have blood work done prior to starting treatment, 2-8 weeks after starting treatment or changing medications, and then every 4-6 months during treatment (CDC, 2024c).

Ensuring a trusting relationship with a healthcare provider allows people living with HIV to understand better their diagnosis, the progression of the disease, and treatment options and to share important information about their treatment challenges. Medications can sometimes cause unpleasant side effects that, to some, may not be tolerable, increasing the risk of dropping out of treatment. Some of the notable side effects include diarrhea and nausea (CDC, 2024c). Other treatment challenges might include the cost of medications. Some of the treatment options can cost upwards of $13,000 per year. Fortunately, there are patient assistance programs available to help cover all or part of this expense (HIV.gov, 2024).

The first major news story about HIV was an article titled "Rare Cancer Seen in 41 Homosexuals," authored by Lawrence K. Altman and appeared in the New York Times. At the time, gay men were developing purple spots on their skin (often appearing as bruises) and enlarged lymph nodes. These young and otherwise healthy men were dying, and physicians did not understand why. A University of California, Los Angeles (UCLA) physician named Michael Gottlieb reported the first cases of HIV/AIDS as an infectious cancer. The article identified the behaviors of these patients as having multiple sexual partners (up to 10 a night), a history of being treated for viral infections such as herpes, cytomegalovirus, and hepatitis B, and a history of intravenous drug use to heighten sexual pleasure. What was later understood was that this was a late-stage presentation of AIDS, now known as Kaposi's Sarcoma.

After the news article was published, rumors began that there was a "gay cancer" spreading, despite evidence that new cases of the disease were developing in straight men and women as well as infants who received blood transfusions. The news article explicitly stated, "There is no apparent danger to non-homosexuals from contagion" (Altman, 1981), which contributed to the ongoing stigma that HIV is only a disease of the Lesbian, gay, bisexual, and transgender (LGBTQ+) community and drug users. In truth, the virus passed from the Caribbean to New York in the early 1970s, where the disease spread for almost fifty years before triggering outbreaks in San Francisco and New York. Misinformation by news outlets contributed to the development of bias and stigma against the LGBTQ+ community.

In 1981, a scientist working for the CDC named William Darrow suspected this new 'gay cancer' was actually a new form of sexually transmitted disease and began to trace the sexual encounters of patients who developed the disease. He found a pattern and began to genetically sequence samples of the virus from infected patients. They found the virus did not originate from Gaëtan Dugas, a Canadian flight attendant originally accused by the media of being "Patient Zero." Dr. Darrow found that the HIV virus came to the United States from Haiti in 1970 (Woroby et al., 2016).

The first decade of the HIV/AIDS epidemic in the United States was a milieu of hysteria targeted at people living with HIV/AIDS. However, the hysteria quickly turned toward what the CDC identified as the four H's, the four high-risk groups: homosexuals, heroin addicts, hemophiliacs, and Haitians. There was a call in the media to tattoo people who had HIV/AIDS, and ballot initiatives were created in California and various other states to quarantine people with HIV (Gonsalves & Staley, 2014).

Stigma and discrimination arise from erroneous attitudes, irrational negative beliefs, and subsequent tyrannical actions (Fauk et al., 2021; Haj-Sheykholeslami et al., 2024), which cause barriers to healthcare prevention and treatment, insufficient service provision by healthcare providers, and eventually increased risk of transmission (Haj-Sheykholeslami et al., 2024; Rosengren et al., 2021).

People with HIV suffer more from HIV-related stigma than the general population (Tadesse et al., 2024). The AIDS epidemic is frequently associated with very negative public responses, including isolating not only patients who are HIV-infected from society but also their family members. Many people diagnosed with HIV/AIDS lose their jobs and housing (Gonsalves & Staley, 2014), sending a message that asymptomatic people are a danger to their communities. Lesbian, gay, bisexual, and intersex (LGBTI) workers reported that within the last year, they experienced a greater incidence of workplace violence compared with their non-LGBTI workers, as well as experiencing greater discrimination in education and employment opportunities (The Joint United Nations Programme on HIV/AIDS [UNAIDS], 2021).

Adolescents living with HIV often experience discrimination from other students or teachers, which impacts their ability to carry medication and manage dosing while in school (UNAIDS, 2021). Crowded milieus with little privacy exacerbate a potential unintended disclosure. Research shows that family-rejecting behaviors predict serious negative outcomes for adolescents with HIV, including suicidality, depression, and drug abuse (Ryan, 2020).

The stigma index analysis (UNAIDS, 2021) found that HIV-related discrimination caused or contributed to job loss in more than 50% of the cases in seven of the eleven countries with data. Jain et al. (2024) found that fear (real or perceived) of potential legal and/or social repercussions resulting from disclosure of their HIV status influenced decisions to conceal their status on applications and in the workplace. This restricted behavior affected their ability to attend medical appointments, their socializing behaviors, and their overall quality of life. Another study found that anti-discrimination workplace policies and provider training on HIV-related confidentiality is an important determinant of HIV-related stigmatizing practices and attitudes (Barbosu et al., 2025).

According to UNAIDS (2021), 21 percent of people living with HIV reported being denied access to care in the past 12 months. Up to 26 percent of women living with HIV reported that receiving HIV treatment was conditional on taking contraceptives. Depending on the cultural or religious beliefs of the person with HIV, this type of restriction on care can create a barrier to treatment. For example, a person of Catholic faith who does not believe in contraception would not adhere to such a requirement.

Some healthcare providers may refuse to care for HIV clients on the grounds of personal biases, thus violating patient rights and ethical medical practice. Negative attitudes greatly impact a client's reluctance to access or return for additional treatment. Unauthorized disclosure of HIV status and consequently creating a Health Insurance Portability and Accountability Act (HIPPA) violation can greatly impact the HIV client by creating social stigma, discrimination, and emotional distress. A study of transgender women in Argentina showed that those who had experienced discrimination in healthcare settings were three times more likely to avoid returning for care (UNAIDS, 2021). In rural areas where providers are in short supply, access to care can be delayed, increasing the risk of poor outcomes. The cost of care might also be a healthcare barrier for clients with HIV. Insurance discrimination, as evidenced by higher premiums, is also a problem. Transportation is a barrier to care as well (Faidas et al., 2024; Fauk et al., 2021).

Self-stigmatization (Jacomet et al., 2025) occurs when environmental stigmas are internalized. When this happens, it often leads to poor self-esteem, isolation, an increase in risky behaviors, and poor quality of life. Individuals may decide not to ask for help out of fear of other people's negative reactions. Studies support that the perception of stigma is strongly associated with reduced willingness to seek professional help and increases negative attitudes towards requesting help (Tadesse et al., 2024).

People living with HIV experience higher rates of mental health disorders than the general population (Remien et al., 2019). Major depressive disorder and generalized anxiety disorder were the top two mental health disorders among people living with HIV (Remien et al., 2019), with rates of post-traumatic stress disorder also higher than the general United States population. Research identifies varied reasons for these findings, including social and biological barriers to accessing and adhering to treatment modalities (AIDS Education & Training Center [AIDSETC], 2022; AIDSETC, n.d.; Remien et al., 2019). Social factors impacting mental health include lack of social resources, transportation, poverty, low education, unstable housing, and food insecurity. Biological factors impacting mental health included comorbid disease states (e.g., hepatitis, diabetes, heart, and bone disease) as well as chronic immune activation (AIDSETC, 2022). Struggles to access adequate care and significant levels of psychiatric distress can interfere with regular HIV testing, staying in care, initiating ART treatment, and achieving HIV viral suppression (AIDSETC, 2022; Remien et al., 2019).

In addition to these challenges, there is strong evidence of a bi-directional correlation between depression and the immune system. The longer and more severe the depressive symptoms persist, the greater the negative impact on CD4 cell decline and the greater the risk for opportunistic infections. The correlation is not fully understood, but research suggests a connection between the hypothalamic-pituitary-adrenal axis dysregulation and intense immune activation (Bingham et al., 2021; Faidas et al., 2024; Remien et al., 2019; Swinkels et al., 2024).

UNAIDS (2023) reports effective strategies to reduce HIV-related stigma and discrimination, including key programs in six settings: community, workplace, education, healthcare, justice, and emergency. In community settings, individual counseling and engagement of families and households with HIV allows for the implementation of services and programs for people living with HIV to protect their health and well-being. In workplace settings, training on workers' rights within the workplace to promote a healthy milieu free from HIV stigma and discrimination is important. UNAIDS (2023) advocates for ensuring adolescents have access to youth-friendly HIV services and comprehensive sexuality education while providing educators with the training and institutional support necessary to meet the psychosocial needs of students living with HIV.

To combat stigma and discrimination in the healthcare setting, UNAIDS (2021) recommends the integration of paralegals into healthcare facilities to provide on-site guidance and awareness campaigns for populations considered "left behind' including people living with HIV, Indigenous populations, people in prisons, migrants and women and girls (particularly adolescent girls) about their rights in accessing services in a discrimination-free milieu. They also advocate for in-service training on HIV, human rights, and medical ethics for all healthcare staff. Ensuring universal precaution supplies, ongoing in-service training for universal precautions, and post-exposure and occupational exposure resources are readily available will reduce avoidance behaviors in people living with HIV.

Working with justice settings to correct misinformation is important in combating stigma and discrimination. Implementing programs to address legal illiteracy and access to care, as well as routinely informing duty-bearers on the legal, health, and human rights aspects of HIV, is vital to establishing informed, compassionate care. Addressing laws that are discriminatory towards vulnerable populations should be part of the national response to HIV. At this time, around 50 countries maintain travel restrictions for people living with HIV, and people from key populations face high levels of violence (UNAIDS, 2020). In emergency settings, programs should be implemented to ensure safe access to care, ensuring appropriate links between outpatient settings and emergency services (UNAIDS, 2023).

Non-governmental organizations (NGOs) have created services within communities that fill the gaps where government programs have failed. The International AIDS Society is the world's largest association of HIV professionals. They advocate for the complete eradication of HIV threat to public health and increased individual well-being (IAS, n.d.). UNAIDS is another international organization that spearheads a global effort to end AIDS as a public health threat with a goal of reaching this milestone by 2030 (UNAIDS, n.d.). KFF is an independent organization that works on health policy research and journalism, focusing on national health issues and the United States' role in global health policy. This organization is based in San Franciso and is supported by an endowment that is supplemented by external funds from foundations that support the work of KFF (KFF, n.d.). Legally, they are considered a public charity. Alternatively, the Gay Men's Health Crisis (GMHC) in New York City has aligned itself with the state and, through collaboration with agencies such as the CDC, has directly challenged the state exacting change in the form of a clean needle exchange. NGOs continue to advocate for better policies and access to care for people with HIV.

Implicit bias can be expressed in the language used to talk about HIV. How people talk about HIV greatly influences feelings of stigma, discrimination, and bias. Certain words have very negative meanings for people who are at high risk of HIV or who are living with HIV. To avoid promoting stigma and misinformation, consider choosing words that are supportive and positive. For example, instead of saying 'AIDS' when referring to HIV, use 'HIV' or the phrase 'HIV and AIDS' when referring to both. AIDS itself is not a condition but rather a syndrome that develops in response to a compromised immune system weakened by the HIV virus. It is important to remember that AIDS cannot be 'caught' or transmitted. People get HIV, and HIV can be transmitted, but it is not hereditary. Instead of saying 'catching AIDS,' say a more positive phrase like 'to acquire HIV; transmit HIV; or to be diagnosed with HIV.' Another example includes exchanging the phrase 'unprotected sex' with 'sex without a condom or medications to prevent or treat HIV (such as PrEP or ART).' Some terms may be considered militaristic and lead others to believe that people with HIV have to be 'fought' or 'eliminated.' Changing language around how behaviors are discussed can help change stigma and discrimination towards people with HIV. Instead of saying 'risky behaviors', replace this phrase with 'people with certain risk factors such as IV drug use which may increase the risk for contracting HIV' (CDC, 2025c).

Implicit bias is the unconscious attitude that people develop towards a specific group that impacts patient care and relationships (Edgoose et al., 2019). Due to the huge impact of bias, delays in treatment can greatly influence long-term health outcomes. Many people with HIV experience this bias by being denied care, having a lower potential for starting ART, and experiencing a lower adherence to ART treatment (Andrasik et al., 2020). Overcoming implicit bias requires an individual to realize their own biases and then to purposefully work towards changing these stereotypes and attitudes. While it is important that individuals work towards this end, it is important to note that organizations and institutions must also work to eliminate system bias (Edgoose et al., 2019). This includes eliminating discriminatory policies and practices that create barriers to care, such as access to affordable housing, promoting the availability of support services within the community, decriminalization of HIV transmission, and increasing access to health care (Andrasik et al., 2020). To better understand the problem, it is important to note that people of color are less likely to achieve viral suppression, and Black and Latina women experience higher rates of morbidity and mortality.

In contrast, Latino men experience shorter life expectancy. To address this issue, healthcare workers, researchers, and service providers must receive formal education about how individual bias influences their practice. Considering individual feelings of bias and how one responds when hearing a client has HIV is an important first step (Andrasik et al., 2020).

According to Edgoose et al. (2019), strategies to remove bias include eight tactics formulated into the mnemonic IMPLICIT, which stands for introspection, mindfulness, perspective-taking, learning to slow down, individualism, check your message, institutionalize fairness, and take two.

Introspection refers to exploring one's implicit bias by identifying one's attitude toward a group. Mindfulness is a practice that reduces stress, such as meditation, yoga, or focused breathing.Perspective-taking considers experiences from the point of view of the person being stereotyped, emphasizing the importance of developing relationships and authentically engaging with the group or persons one has a stereotype about (e.g., patients with HIV). Learning to slow down allows one to reflect and think about the bias identified and why one feels the way they do about the group. The concept of individuation refers to evaluating people based on their personal characteristics rather than those affiliated with their group. This could be accomplished by connecting over a shared interest, hobby, or background.Checking the message involves understanding how language impacts the group or person within the group. Using welcoming and positive messaging helps promote a safe and inviting milieu.

When institutional fairness is missing, it is important to identify areas where change is needed and speak up about possible solutions for change. Keeping organizations and institutions accountable towards the goal of health equity is vital to better outcomes. The final strategy to combat implicit bias identified by Edgoose et al. (2019) refers to cultural humility and the lifelong process of self-reflection. Bias can creep back into one's life at any point, and being self-aware and constantly working to identify and eradicate bias not just in one's own person but in our institutions and organizations will help the communities we live in and serve for generations to come.

Mary and Joe Martin, a middle-class couple from rural Kansas, had long desired to adopt a child. After years of paperwork and waiting, they were overjoyed to welcome a newborn baby girl, whom they named Jacklynn, into their home. The adoption process went smoothly, and they embraced the challenges and joys of parenthood. However, their world was shaken when they received a call from the adoption agency six weeks later. Jacklynn's biological mother had recently tested positive for HIV, raising immediate concerns about Jacklynn's health. The adoption agency explained that the biological mother did not disclose her HIV risk due to social stigma and fear that she would no longer have access to the medical care she desperately needed.

The Impact of Social Stigma 

As the Martins sought guidance from family, friends, and their community, they quickly encountered the stigma surrounding HIV. Their closest friends, Bill and Karen Minor, distanced themselves, while family members expressed concerns about Jacklynn's future and whether she could safely interact with other children. When Mary Martin disclosed her daughter's potential health condition, the daycare provider decided she could no longer provide services for them. This social stigma added emotional strain, leaving them feeling isolated when they needed support the most.

Medical Evaluation and Treatment Options

Upon learning of Jacklynn's potential exposure to HIV, the Martins immediately consulted a pediatric infectious disease specialist in Kansas City. The medical team performed a series of tests, including a complete blood count (CBC) with nucleic acid tests (e.g., DNA and RNA polymerase chain reaction (PCR) assays), to determine whether Jacklynn had contracted the virus.

Fortunately, early testing showed that Jacklynn was not HIV-positive. However, due to the risk of perinatal transmission, the doctors recommended a preventive treatment regimen. She was prescribed a six-week course of Zidovudine (AZT) to reduce the likelihood of developing HIV. The Martins remained vigilant with regular follow-ups, ensuring she continued to test negative over time.

Healthcare Barriers

The family faced significant healthcare barriers, both systemic and personal. Initially, finding a pediatric specialist familiar with HIV-exposed infants proved challenging, as many local pediatricians lacked experience in this area. Additionally, navigating insurance coverage for the necessary medications and frequent medical tests was overwhelming. Some insurers require extensive documentation to justify coverage for preventive HIV treatment, delaying essential care.

Beyond insurance, the stigma within the healthcare system itself was evident. Some medical staff made insensitive comments, assuming Jacklynn was infected before confirming the test results. Mary Martin also felt the sting of stigma as some providers assumed she was the biological mother who had HIV and exposed her infant daughter. To some degree, Mary Martin also struggled with anger towards the biological mother for putting Jacklynn in this position. After some self-reflection, she understood that this was her own bias towards the biological mother. The Martins had to advocate fiercely for their daughter's right to unbiased, high-quality medical care.

Financial Struggles

Jacklynn's health concerns placed a significant financial strain on the family. The cost of frequent hospital visits, specialized blood tests, and antiviral medications quickly accumulated. Even with health insurance, the out-of-pocket expenses were substantial. Additionally, the Martins had to take time off work for medical appointments, travel to Kansas City, and often stay overnight in hotels for early appointments, leading to lost income.

The social stigma also affected their financial situation indirectly. The daycare provider quit, meaning that either Mary or Joe had to miss work or reduce their working hours, impacting the family's financial stability. The stress of mounting bills and uncertainty about Jacklynn's future made the experience even more difficult.

Overcoming Challenges and Finding Support

Despite these challenges, the Martins found solace in support groups for families affected by HIV, connecting with others who understood their struggles. They also worked with advocacy organizations to spread awareness about perinatal HIV transmission and to combat misinformation. Over time, they built a new support system composed of compassionate healthcare professionals and like-minded parents who embraced Jacklynn without fear or prejudice.

The Martins family's experience highlights the multifaceted challenges that adoptive parents may face when dealing with an HIV-related diagnosis. From battling social stigma to navigating complex healthcare systems and financial burdens, they demonstrated resilience and unwavering commitment to their daughter's well-being. The importance of education, advocacy, and community support are crucial in reducing HIV-related stigma and ensuring every child has access to the care and love they deserve.