HIV disclosure and stigma among couples in Muslim communities in Indonesia: a qualitative study

Background

HIV-related stigma remains a major barrier to disclosure, prevention, and treatment, yet little is known about how stigma operates within intimate relationships in Muslim-majority settings. Indonesia, home to the world’s largest Muslim population, faces a growing burden of heterosexual HIV transmission, with disclosure and prevention being deeply shaped by religious and moral norms.

Methods

We conducted a qualitative study involving individuals from serodiscordant and seroconcordant couples, Muslim religious leaders (Ustaz), provincial health authorities, the Director of YPKDS, and the representatives of Nahdatul Ulama. Data were collected through 14 in-depth interviews (IDIs) with individuals from serodiscordant couples, two focus group discussions (FGDs) with 14 participants from seroconcordant couples, and one FGD with seven representatives from HIV-focused NGOs. Triangulation of data sources and methods was used to enhance the depth and credibility of the findings.Data were analyzed using reflexive thematic analysis.

Results

Stigma emerged across five themes: (1) Stigma Related to HIV Status; (2) Healthcare Provider Stigma; (3) Stigma Related to Condom Use; (4) Serodiscordancy and Disclosure Dynamics; and (5) Community and Religious Actors in Shaping Stigma Narratives. Stigma influenced decisions on disclosure, condom use, and social engagement. Participants emphasized the essential role of Muslim religious leaders and community organizations in shaping perceptions, reducing stigma, and supporting disclosure.

Conclusions

HIV-related stigma in Muslim communities operates across relational, moral, and institutional levels. HIV services should integrate disclosure support into routine care, strengthen couple-based communication and counseling, and engage religious and community leaders in stigma-reduction initiatives. Such approaches may help create safer and more supportive environments for disclosure, prevention, and long-term engagement in HIV care.