Characteristics of ALWH participants.

Suicide is the second leading cause of death for adolescents worldwide. Adolescents living with HIV (ALWH) in Malawi are particularly at risk, due to stigmatization and a high comorbid prevalence of depression. Internalized stigma is an indicator of depression and suicidality, yet we have a limited understanding of the drivers and impacts of internalized stigma. In this analysis, we assessed how death-centric stereotypes and experienced stigma contribute to the development of internalized stigma and elevate suicide risk for ALWH in Malawi. This qualitative study recruited 68 total participants from three government healthcare facilities in Lilongwe, Malawi. We conducted 13 in-depth interviews and 10 focus group discussions with ALWH, caregivers of ALWH, adolescent peers without HIV, schoolteachers, HIV care providers, and mental health providers. We sought to understand how stigma manifests in key parts of an ALWH’s life and contributes to internalized stigma and suicidal ideation. Guided by thematic analysis, we organized the relevant data into four themes: death-centric stereotypes, experienced stigma, internalized stigma, and suicidality. Death-centric stereotypes were identified as HIV’s association with being a death sentence, obstructing one’s future, and weak physical and mental capacity. From these stereotypes originate specific manifestations of experienced stigma, including insults and mockery, reduced social and economic prospects for adulthood, caregiver lack of investment in vital resources, and exclusion from community activities. Stereotypes and experienced stigma contribute to internalized stigma which manifests as low self-esteem, loss of future-oriented mindset, and self-isolation. This stigmatization process, particularly when perpetuated by family, increased suicide risk for ALWH. This study describes how death-centric stereotypes dominate the public discourse around ALWH, influence stigmatizing behaviors towards ALWH that disenfranchise them in their daily lives, and contribute to the development of internalized stigma and suicidality. Suicide screening and prevention programming, with attention to culturally sensitive stigma reduction, is urgently needed for ALWH.自杀是全球青少年群体的第二大死亡原因。马拉维的HIV感染青少年（Adolescents Living with HIV, ALWH）因污名化现象及共病抑郁的高患病率，面临尤为突出的自杀风险。内在化污名是抑郁与自杀意念的预测因子，但目前学界对内在化污名的驱动因素与影响机制仍知之甚少。本研究旨在分析马拉维HIV感染青少年中，以死亡为核心的刻板印象与亲历污名如何推动内在化污名的形成，并加剧其自杀风险。 本项质性研究从马拉维利隆圭的三家公立医疗机构共招募了68名参与者，对HIV感染青少年、其照护者、未感染HIV的青少年同伴、学校教师、HIV医疗照护人员及精神卫生服务人员开展了13次深度访谈与10次焦点小组讨论。 本研究旨在探究污名在HIV感染青少年生活关键场景中的表现形式，及其如何推动内在化污名与自杀意念的产生。 本研究采用主题分析法，将相关数据归纳为四大主题：以死亡为核心的刻板印象、亲历污名、内在化污名与自杀相关行为。 研究发现，以死亡为核心的刻板印象表现为将HIV等同于死刑判决、阻碍个人未来发展以及削弱身心机能。 此类刻板印象催生了亲历污名的具体表现形式，包括言语侮辱与嘲讽、成年后社会与经济前景受限、照护者未为其投入必要资源，以及被排除在社区活动之外。 刻板印象与亲历污名共同推动内在化污名的形成，其表现为自卑心理、丧失面向未来的心态与自我孤立。 此类污名化过程，尤其是当污名来自家庭时，会进一步加剧HIV感染青少年的自杀风险。 本研究阐明了以死亡为核心的刻板印象如何主导针对HIV感染青少年的公共话语，如何催生针对他们的歧视性行为并使其在日常生活中被剥夺权益，进而推动内在化污名与自杀相关行为的形成。 针对马拉维的HIV感染青少年，亟需开展自杀筛查与预防项目，并关注符合文化语境的污名消减策略。