In the United States, more than half (54%) of people diagnosed with HIV are aged 50 and older (1), and women aged 35 and older account for 58% of new diagnoses among women (2). However, there are currently no national statistics reporting the number of older women living with HIV (WLWH), highlighting a critical gap in research and surveillance efforts. What is known is that older WLWH experience a higher burden of comorbid diseases (3) and are particularly vulnerable to social isolation and depression (4–6). Additionally, they face unique challenges, including HIV-related stigma, often compounded by ageism and sexism, with women being more adversely impacted than men (7).

Older WLWH occupy a distinct and often overlooked space, where the effects of aging intersect with the long-term realities of living with HIV. Physiologically, aging with HIV can accelerate the onset of comorbidities such as cardiovascular disease, osteoporosis, and neurocognitive disorders (8). Additionally, studies have shown that as older WLWH transition through menopause, they experience elevated rates of somatic and psychological symptoms that can further compromise physical and emotional wellbeing (9). Psychosocially, older WLWH frequently encounter compounded stigma related to both HIV and age, which can contribute to social isolation, depression, and diminished quality of life (10, 11). These experiences are often exacerbated by intersecting forms of discrimination, including ageism, sexism, and racism, which may heighten feelings of invisibility, shame, or reduced self-worth (12–14). Additionally, systemic barriers, such as socioeconomic disadvantage and limited access to age-appropriate, HIV-competent healthcare, further compound the challenges faced by this population (15).

WLWH are particularly vulnerable to stigma due to prevailing gender stereotypes that blame women for their HIV status (16) and societal expectations related to motherhood, sexuality, and morality (17). Regionally, WLWH in the Southern United States face compounded experiences of stigma and social isolation due to culturally conservative views regarding HIV transmission and gender roles (18). Among older WLWH, this stigma is often intensified, as expectations around caregiving, motherhood, and moral responsibility become more deeply ingrained with age, amplifying the perceived transgression (19). This intensified stigma often persists into older adulthood, adversely affecting quality of life and engagement in care (20, 21).

In 2023, we published A Qualitative Metasynthesis of Stigma in Women Living with HIV in the United States (22) to examine the current state of stigma since the previous metasynthesis (23) and to guide the development of a stigma reduction intervention specifically tailored to the experiences of WLWH. The gender inequities observed in our metasynthesis mirror findings reported by others, highlighting the ongoing pervasiveness of both felt and enacted stigma, as well as the gender-linked intensification of HIV stigma (19, 24). Such enduring inequities underline the need to better understand and address the experiences of stigma among older WLWH. For older WLWH, mitigating stigma is particularly critical to improving psychosocial wellbeing and reducing health inequities in this growing demographic (25).

In our previous work, we conducted a randomized clinical trial (RCT) to test the feasibility, acceptability, and preliminary efficacy of a video-based self-management intervention, Maybe Someday: Voices of HIV-Positive Women (26). The results demonstrated significant improvements in self-esteem, reduced internalized stigma, and enhanced coping self-efficacy. However, over the past decade, the media landscape has shifted dramatically toward digital platforms, characterized by on-demand access to content across various devices and gravitation toward shorter video formats (27, 28). Therefore, this video intervention was adapted to reflect changes in both media consumption and stigma for WLWH.

Despite growing awareness, stigma interventions specifically targeting WLWH remain limited (29). Some exceptions include the UNITY intervention, a stigma-reduction program for African American WLWH (30), and early applications of technology, such as our use of an iPod Touch device for stigma reduction among WLWH (31). Psaros et al. also piloted an app to promote resilience among older WLWH (32). A recent review highlights the critical need for social support and stigma reduction across the lifespan for older adults living with HIV (33). However, interventions specifically designed for older WLWH remain scarce (34, 35). Building on previous findings and addressing critical gaps in the literature, this study explored the acceptability, personal relevance, and perceived effectiveness of a series of stigma-reduction videos among older women living with HIV (WLWH) in the Southern U.S., with the aim of reducing stigma across the lifespan.

Using a focus group of older women living with HIV (WLWH) in the Southern U.S., this article explored the acceptability, personal relevance, and perceived effectiveness of a stigma-reduction video series focused on the lifecycle of stigma. Grounded in a prior metasynthesis of qualitative literature on HIV-related stigma, the videos were designed to reflect the lived experiences of WLWH, challenge stigma, and foster discussion and resilience. Focus group findings offer insight into the ongoing burden of HIV stigma, the evolving process of aging with HIV, and the potential of visual storytelling as a meaningful tool for stigma reduction, suggesting early promise for future application.

The videos resurfaced powerful memories of early HIV-related stigma among participants, many of whom were diagnosed decades ago. Although long past, these moments remained emotionally vivid, highlighting the profound and lasting impact of institutional stigma in healthcare settings, also documented in contemporary research (53). These reflections revealed how early experiences of stigma continue to shape the identity and the emotional evolution of aging with HIV (43). This response underscores the enduring toll of HIV stigma and supports contemporary research showing that internalized stigma can persist for older WLWH even as HIV becomes increasingly normalized within clinical and social contexts (20). Feelings of not belonging or discomfort, even in the absence of overt discrimination, reflected how early experiences with stigma continue to influence self-perception. Despite years of actively advocating and opposing stigma, many participants acknowledged the difficulty of fully shedding concern for societal judgment. This tension may be heightened for older WLWH, who continue to carry the weight of historical and intersectional stigma (14, 16).

Age emerged as a powerful lens through which participants engaged and interpreted the videos. With an average of 24 years since diagnosis, many women described a long arc of adjustment from initial trauma to self-acceptance and advocacy, mirroring findings from research and our metasynthesis, which suggests older WLWH often demonstrate emotional adaptation and resilience over time, despite the compounded stigma of aging and HIV (44, 45). The videos served as a springboard for this dialogue, helping participants articulate how aging with HIV is not only about surviving but about growing into a fuller sense of purpose and self. For many, aging with HIV has brought a deeper understanding of the condition and a strong sense of responsibility to educate others, especially younger women. Education was seen as empowering and essential, and the videos reinforced the value of sharing knowledge to prevent future stigma and hardships (46, 47).

Direct feedback on the videos revealed that visual presentation played a key role in how participants received the videos. Videos 2 and 3, which paired emotionally resonant narratives with stock imagery, were viewed as more engaging and impactful than the still frames in Video 1. This preference aligns with research indicating a broader shift toward concise, visually stimulating video formats that enhance viewer engagement (48). Although such formats are often associated with younger audiences, our findings suggest that older viewers also appreciate and respond well to shorter, visually rich content. Participants also offered suggestions for enhancing the videos' impact. They recommended incorporating more educational content, particularly around basic HIV facts, to expand their usefulness for both WLWH and broader public audiences. Several emphasized the value of structuring future videos around different phases of the HIV journey, from diagnosis through long-term survivorship, to better reflect the full range of experiences and the evolving nature of living with HIV.

A major strength of this work is the integration of the metasynthesis with intervention development to root the intervention in a collective experience. By translating synthesized themes into scripted narratives, the videos conveyed broad yet nuanced concepts and perspectives. Additionally, the focus group allowed content to be developed with the target audience rather than for them, supporting the acceptability and relevance of the content. We previously developed and tested a longer-form video intervention to address HIV-related stigma among WLWH, which demonstrated reduced internalized stigma and improved self-efficacy in coping. Building on that success, this study explores a short-form, narrative-driven approach. While growing evidence suggests that brief, narrative-driven video interventions grounded in authenticity can effectively engage participants and reduce mental health stigma (49, 50), this study is, to our knowledge, the first to explore a short-form video intervention specifically for reducing HIV-related stigma among WLWH. Additionally, this holds tremendous potential due in part to its ability to reach beyond physical sites to engage individuals where they feel safe, a necessary component of any intervention targeting stigmatized populations (51). Furthermore, it has the capability to continue uninterrupted during disease outbreaks, like the COVID-19 pandemic, without restriction (52).

Nonetheless, several limitations should be acknowledged. The sample, while representative of diverse life experiences, was regionally bound to the Southern U.S. and may not reflect the perspectives of WLWH from other cultural or geographic backgrounds. To this demographic point, we did not capture the impressions of younger WLWH, and the interventions would benefit from incorporating their perspectives to produce the suggested educational content in the phases of diagnosis. Additionally, the single-session format may have influenced group dynamics, potentially amplifying agreement or limiting dissenting views that may have emerged in subsequent sessions. Finally, although no participants reported distress during or after the focus group, the potential for emotional discomfort should be acknowledged. The videos prompted some participants to recall painful or stigmatizing experiences from earlier in life. However, encouraging this type of reflection was a central aim, as acknowledging and validating these experiences is essential to reducing stigma and fostering healing. While the setting and procedures were designed to support emotional safety, future implementations should continue to consider the risk of resurfacing difficult memories and ensure that appropriate support is available when the videos are used in group or individual settings.

Our study highlights the potential of brief, narrative-based videos to engage WLWH in meaningful reflection and dialogue about HIV-related stigma. The participants' responses revealed not only the emotional resonance of the content but also the enduring impact of stigma across the lifespan. Participants emphasized the need for future interventions to reflect the full arc of the HIV journey, from diagnosis to long-term survivorship, and to include more educational content. They also offered clear preferences for engaging, visually dynamic formats. As the HIV population continues to age, there is a growing need for interventions that honor the complexities of long-term survivorship, address persistent stigma, and incorporate the voices of older WLWH (13, 32). Future work is needed to build on these findings by incorporating multigenerational perspectives, expanding educational content, and refining the visual presentation of video materials based on participant feedback. After refinement, we aim to expand this intervention to include younger WLWH and participants from other regions in the U.S. The video format is brief, cost-effective, and optimized for virtual delivery across multiple platforms, making it highly scalable and adaptable to diverse settings. The videos are well-suited to complement existing peer support programs, care engagement apps, and support groups by fostering reflection, discussion, and connection. As such, they could be readily integrated into care management across HIV services, community-based organizations, and digital platforms. Following refinement of the videos based on this formative work, longitudinal research will be necessary to assess their sustained impact.