HIV-Related Stigma and Serostatus in Homophobic and Serophobic Violence Within LGBTIQA+ Populations: A Systematic Review

This study synthesizes empirical evidence on how HIV-related content (serostatus, HIV risk indicators, and HIV-related stigma/serophobia) is associated with violence and exclusion within LGBTIQA+ relationships (friendships or romantic relationships) and within LGBTIQA+ contexts (e.g., bars/nightclubs, organizations, and digital platforms). It examines mechanisms of stigmatization linked to HIV-positive status and sexual orientation, manifestations of violence across multiple levels (interpersonal, community, institutional), and consequences for health and well-being.

A PRISMA 2020-guided systematic review was conducted in PubMed, Scopus, Web of Science, and SciELO (January 1, 2019–June 30, 2025). Only empirical studies published within this period constitute the systematic evidence base and are included in the PRISMA flow diagram and the NHLBI/NIH quality appraisal (empirical evidence set: n = 22). Separately, an integrative conceptual component (2003–2018) and one contemporary conceptual paper were used exclusively for contextualization and interpretive sensitization. These conceptual sources are reported independently, are not counted in the PRISMA totals, and are not assessed with the NIH tool.

Across the empirical evidence base, HIV-related content (serostatus, risk indicators, or HIV-related stigma) was unevenly operationalized. In the subset of studies that explicitly addressed HIV-related variables, HIV-related stigma and serostatus were reported alongside relational tensions and intracommunity exclusion in LGBTIQA+ relationships and social/digital contexts. In parallel, consistent evidence indicates that heteronormative and cisnormative discourses, as well as hegemonic masculinity, permeate LGBTIQA+ relationships and settings, shaping hierarchies of desirability and belonging.

Within the included empirical literature, HIV-related stigma and serostatus, when explicitly measured, are associated with patterns of intracommunity exclusion and relational violence, particularly when intersecting with other vulnerabilities (gender, race, poverty). Given that most studies are cross-sectional and HIV-related variables were inconsistently measured, these findings should be interpreted as associative and context-dependent rather than causal. The review challenges homogenizing notions of an LGBTIQA+ “community” and provides research directions for the design of interventions (evaluation, implementation, and assessment) that address heteronormative practices and discourses within LGBTIQA+ adult relationships and contexts.

HIV-related stigma and serostatus, when explicitly measured, are associated with intracommunity exclusion and relational violence, particularly at the intersection of other vulnerabilities. Future research should specifically examine serophobia within LGBTIQA+ populations, develop interventions grounded in the U=U principle, and adopt longitudinal designs to establish causal pathways. The exclusive use of Spanish and English, the restricted time frame (2019–2025), and reliance on indexed literature may have led to the exclusion of relevant studies (including grey literature).