Beyond Diagnosis: Structural Stigma, Trauma, and Mental Health Among People Living with HIV in Tunisia: A Narrative Review

Abstract

HIV-related stigma constitutes a critical structural determinant that adversely affects mental health and treatment outcomes among people living with HIV (PLWH) in Tunisia. Rooted in cultural conservatism, legal criminalization, and institutional discrimination, this stigma engenders social exclusion, the systematic removal of individuals from community participation. It further fosters internalized shame, precipitating depression, anxiety, and treatment non-adherence. Evidence was synthesized from English- and French-language literature published between 2014 and 2026, identified through targeted searches of PubMed, Scopus, Web of Science, Google Scholar, and grey literature sources from UNAIDS, WHO, and Tunisian governmental authorities. This narrative review synthesizes recent epidemiological data indicating a 0.1% general population prevalence but 13% among men who have sex with men (MSM), with only 26% testing coverage. Situated within trauma-informed, social determinants of health, and public health frameworks, this analysis identifies specific vulnerabilities for women and older adults living with HIV. Integrated approaches combining healthcare-provider training, legal reform, and culturally tailored mental health services are essential to mitigate the harms of stigma and improve equitable health outcomes in Tunisia.