Stigma and Discrimination Against People Living with HIV in Dental Care: A Field Study of Dentists' Practices and Patients' Experiences of Concealing Their HIV Status in Mashhad

Fouladiyan, Majid; Jafaraghaei, Saeedeh; Faezi, Mahdi

doi:10.22034/jss.2026.2086899.1944

Stigma and Discrimination Against People Living with HIV in Dental Care: A Field Study of Dentists' Practices and Patients' Experiences of Concealing Their HIV Status in Mashhad

نوع مقاله : مقاله پژوهشی

نویسندگان

Majid Fouladiyan ¹

Saeedeh Jafaraghaei ²

Mahdi Faezi ²

¹ Associate Professor of Sociology, Department of Social Sciences, Faculty of Humanities, Ferdowsi University of Mashhad, Razavi Khorasan, Mashhad, Iran

² M.A. in General Psychology, Department of Psychology, Faculty of Humanities, Ferdowsi University of Mashhad, Razavi Khorasan, Mashhad, Iran

10.22034/jss.2026.2086899.1944

چکیده

Background and aim: Despite advances in HIV prevention and treatment, stigma and discrimination against People Living with HIV (PLHIV) remain pervasive within healthcare settings, particularly in dental care. This study explored the multilayered processes of exclusion and concealment experienced by PLHIV in dental services, with a particular focus on the discrepancy between dentists' professional knowledge and clinical practice and the lived experiences of patients in Mashhad, Iran.
Data and method: A qualitative field study was conducted using two complementary components. First, participant observation was employed to examine the clinical practices of 55 dentists across three socioeconomic districts of Mashhad under real-world conditions, with the researcher presenting as a person living with HIV. Second, semi-structured interviews were conducted with eight PLHIV recruited through a Behavioral Diseases Counseling Center. Observational and interview data were analyzed using qualitative content analysis.
Findings: Of the 55 dentists observed, 38 demonstrated exclusionary practices by refusing treatment or referring patients elsewhere. Exclusion was most prevalent in the high socioeconomic district and least common in the low socioeconomic district. Referral to designated treatment centers emerged as the dominant exclusionary practice, often resulting in prolonged treatment-seeking pathways. Interview findings indicated that fear of stigma, shame, anger, and hopelessness shaped patients' experiences following HIV diagnosis. Concealment of HIV status functioned as a strategy for balancing the need for treatment against anticipated discrimination. While supportive institutional environments enhanced quality of life and social participation, discriminatory experiences within healthcare, family, educational, and occupational settings reinforced concealment and internalized stigma.
Conclusion: The exclusion of PLHIV from dental care reflects not technical limitations but the social construction of HIV, a persistent knowledge–practice gap among dental professionals, and deficiencies in health policy and regulatory oversight. Strengthening regulatory mechanisms, implementing simulation-based practical training for healthcare providers, and reinforcing anti-discrimination policies are essential to reducing institutional stigma and improving equitable access to dental care.

کلیدواژه‌ها

HIV/AIDS

People Living with HIV (PLHIV)

Dentists

Dental Care

Stigma

Discrimination

Concealment

Health Services

Anthony, L. E. (2011). An investigation into employees' perceptions of HIV/AIDS stigma and their attitudes and behaviour towards HIV positive colleagues (Master’s thesis, Stellenbosch University).

Becker, H.S. (1963). Outsiders: Studies in the sociology of deviance. New York: Free Press.

Behrovan, H., Noughani, M., & Abachi, A. (2011). Investigating the process of labeling people living with HIV/AIDS and its consequences: A case study. Iranian Journal of Sociology, 12(3), 143–166. https://doi.org/10.22034/jss.2022.522796.1493 {In Persian}.

Cheraghi, A., Esmaeili-Nasab, M., & Rasoulzadeh Tabatabaei, S. (2016). Comparison of hostility among women with and without HIV/AIDS. Quarterly Journal of Psychological Health Research, 9(4), 32–45. http://dx.doi.org/10.18869/acadpub.rph.9.4.32 {in Persian}

Childress, S., Shrestha, N., Kreniske, P., Small, E., Gilbert, L., Mukambetov, A., Ssewamala, F., Sensoy Bahar, O., & McKay, M. (2024). Social stigma and vulnerabilities of women living with HIV/AIDS in Kyrgyzstan: Service providers' perspectives. Families in Society: The Journal of Contemporary Social Services. https://doi.org/10.1177/10443894241272203

Deng, R., Li, J., Sringernyuang, L., & Zhang, K. (2007). Drug abuse, HIV/AIDS, and stigmatisation in a Dai community in Yunnan, China. Social Science & Medicine, 64(8), 1560–1571. https://doi.org/10.1016/j.socscimed.2006.11.006

Dessie, Z.G., & Zewotir, T. (2024). HIV-related stigma and associated factors: A systematic review and meta-analysis. Frontiers in Public Health, 12, Article 1356430. https://doi.org/10.3389/fpubh.2024.1356430

Earnshaw, V.A., & Chaudoir, S.R. (2009). From conceptualizing to measuring HIV stigma: A review of HIV stigma mechanism measures. AIDS and Behavior, 13(6), 1160–1177. https://doi.org/10.1007/s10461-009-9593-3

Earnshaw, V.A., Smith, L.R., Chaudoir, S.R., Amico, K.R., & Copenhaver, M.M. (2013). HIV stigma mechanisms and well-being among PLWH: A test of the HIV stigma framework. AIDS and Behavior, 17(5), 1785–1795. https://doi.org/10.1007/s10461-013-0437-9

Elmi, Z., Soudagar, S., Hosseinzadeh Taqavai, M., Salahian, A., & Hosseini Shokouh, S.J. (2025). Comparing the effectiveness of schema therapy and compassion-focused therapy on self-criticism and stigma among people living with human immunodeficiency virus. Medical Journal of Mashhad University of Medical Sciences, 67(4), 1075–1088. https://doi.org/10.69107/amh-165358 {in Persian}

Giuliani, M., Patini, R., Lo Muzio, L., Troiano, G., Caponio, V.C.A., Adamo, D., Conti, F., Gallenzi, P., & Lajolo, C. (2023). Attitudes and practices of dentists treating HIV+ patients in the era of new antiretroviral therapy: A 12-year update. Heliyon, 9(8), Article e18751. https://doi.org/10.1016/j.heliyon.2023.e18751

Goffman, E. (1963). Stigma: Notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice-Hall.

Gruszczyńska, E., & Rzeszutek, M. (2023). HIV/AIDS stigma accumulation among people living with HIV: A role of general and relative minority status. Scientific Reports, 13, Article 10709. https://doi.org/10.1038/s41598-023-37948-7

HIV Justice Network. (2024). 2024 in review: Progress amid challenges. https://www.hivjustice.net/news/2024-in-review-progress-amid-challenges/

Jafari, A., Khami, M. R., Yazdani, R., Mohammadi, M., & Zarei, M. (2012). Effect of an educational course at an Iranian dental school on students' knowledge of and attitudes about HIV/AIDS. Journal of Dental Education, 76(6), 792–799. https://doi.org/10.1002/j.0022-0337.2012.76.6.tb05315.x {in Persian}

Jalali, A., Shams, M., Shariatinia, S., Shahrani, A., & Maleki, M. (2024). Improving HIV/AIDS literacy in teachers by easy-to-read materials: A brief report. Armaghane Danesh, 28(6), 911–918. https://doi.org/10.61186/armaghanj.28.6 {in Persian}

Jiménez, J., Puig, M., Sala, A.C., Ramos, J.C., Castro, E., Morales, M., & Zorrilla, C. (2011). Felt stigma in injection drug users and sex workers: Focus group research with HIV-risk populations in Puerto Rico. Qualitative Research in Psychology, 8(1), 26–39. https://doi.org/10.1080/14780880903304532

Karram, S., Sanger, C., Convery, C., & Brantley, A. (2024). Social determinants of health among persons living with HIV impact important health outcomes in Michigan. AIDS and Behavior, 28(2), 547–563. https://doi.org/10.1007/s10461-023-04243-5

Link, B.G., & Phelan, J.C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385. https://doi.org/10.1146/annurev.soc.27.1.363

McCarthy, G.M., Koval, J.J., & MacDonald, J.K. (1999). Factors associated with refusal to treat HIV-infected patients: The results of a national survey of dentists in Canada. American Journal of Public Health, 89(4), 541–545. https://doi.org/10.2105/AJPH.89.4.541

Momeni-Rad, A., Aliabadi, K., Fardanesh, H., & Mazini, N. (2013). Qualitative content analysis in research methodology: Nature, stages, and trustworthiness of findings. Quarterly Journal of Educational Measurement, 4(14), 187–222. https://jem.atu.ac.ir/article_92.html?lang=en {in Persian}

Operario, D., Sun, S., Bermudez, A.N., Masa, R., Shangani, S., van der Elst, E., & Sanders, E. (2022). Integrating HIV and mental health interventions to address a global syndemic among men who have sex with men. The Lancet HIV, 9(8), e574–e584. https://doi.org/10.1016/S2352-3018(22)00076-5

Rabiee, M., & Kazemnejad Leili, E. (2012). Knowledge and attitude of general dentists regarding HIV and hepatitis infections in Rasht. Research in Medical Education, 4(1), 58–67. https://doi.org/10.18869/acadpub.rme.4.1.58

Saeedi, H., Akbari, H., Fuladiyan, M., & Varshoui, F. (2022). Social determinants associated with disease diagnosis in women with breast cancer. Iranian Journal of Breast Diseases, 15(3), 45–66. https://doi.org/10.30699/ijbd.15.3.45

Shakouri, A., & Darkesh, M. (2013). An exploratory study of the socioeconomic status of people living with HIV/AIDS in Iran: A case study of patients hospitalized in Imam Khomeini Hospital, Tehran. Iranian Journal of Social Problems, 4(1), 21–43. https://doi.org/10.22059/ijsp.2013.50657 {in Persian}

Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.). Thousand Oaks, CA: Sage Publications.

Wendt, G.W., Chaves, L.W., & Costa, A.B. (2025). Exploring the influence of age, gender, stigma, and years living with HIV on mental health outcomes. HIV Medicine, 26(11), 1684–1693. https://doi.org/10.1111/hiv.70098

World Health Organization. (2025). HIV data and statistics. https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/hiv/strategic-information/hiv-data-and-statistics