مجله مطالعات اجتماعی ایران

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.