A Qualitative Examination of HIV-Related Microaggressions In Social Services Settings

Background and Purpose: In 2024, an estimated 40.8 million people globally were living with human immunodeficiency virus (HIV), including 1.4 million in mainland China. Although HIV is now considered a chronic disease, people living with HIV continue to face numerous challenges, particularly stigma stemming from misconceptions about how HIV is transmitted. In China, research on the experiences, challenges, and needs of people living with HIV in social services settings remain limited. Moreover, little is known about how stigma manifests in the everyday interactions between social work professionals and people living with HIV.

This study addresses this gap by examining microaggressions in interactions between people living with HIV and social work professionals, and by exploring how and why such microaggressions develop from social work professionals' perspective.

Methods: A qualitative design was employed, incorporating participant observation and in-depth interviews. The third author spent four months (June to September 2024) in a selected social services agency to understand the setting, group culture, and interactions between professionals and clients living with HIV, and subsequently conducted individual, face-to-face semi-structured interviews in October and November 2024.

Purposive sampling was used. A total of 16 interviews were completed: eight clients (6 male) with HIV durations ranging from 14 to 22 years, and eight professionals, with experience working with people living with HIV ranging from 6 to over 20 years.

Interviews lasted 40–60 minutes and were transcribed verbatim. Thematic analysis was adopted using Braun and Clarke’s six-phase framework with ATLAS.ti 8.0 software.

Findings: All participants reported that microaggressions were subtle and covert, yet widespread in interactions between clients and professionals. Seven categories of microaggressions were identified: (1) Exclusion of people living with HIV, particularly certain groups such as men who have sex with men, (2) Incorrect assumptions about how clients contracted HIV, (3) Overprotective care toward people living with HIV, (4) Separating people with HIV from other clients, (5) Providing inferior services, (6) Use of negative slurs or judgmental comments regarding client behaviors, (7) Delivering advice in a scolding or authoritarian manner.

Professionals also described how microaggressions develop and are perpetuated, citing three primary reasons: (1) Misperceptions about HIV transmission, (2) Assumptions that HIV is highly contagious, leading to overprotective behavior among professionals, (3) Reinforcement of these misconceptions within the professional group, unconsciously normalizing microaggressive practices.

Conclusions and Implications: Findings reveal that microaggressions are pervasive even among professionals in social services settings and that erroneous assumptions and practices can reinforce one another in a cyclical manner. Social work professionals therefore require not only accurate knowledge about HIV but also skills for interacting respectfully and effectively with clients living with HIV. Moreover, social service agencies need to review and improve their policies and institutional practices to ensure that clients living with HIV are treated equitably and do not feel separated from other clients.

Future research should explore how people living with HIV cope with microaggressions and examine strategies that could help professionals break the cycle of microaggressions and engage with clients in a respectful, inclusive, and effective manner.