Community and healthcare provider perspectives on HIV- and COVID-19–related stigma, fear and health-seeking barriers among pregnant and breastfeeding women in Uganda

Background Stigma and fear associated with HIV/AIDS and COVID-19 remain major barriers to healthcare access, particularly for pregnant and breastfeeding women. These intersecting social processes may undermine health-seeking behavior, treatment adherence, and maternal health outcomes. The study explored experiences of HIV stigma, COVID-19–related fear, and health-seeking barriers among pregnant and breastfeeding women, healthcare workers, and community stakeholders in Uganda. Methods A qualitative study was conducted in selected districts in Uganda in March-July 2025. Data were collected using 12 focus group discussions (FGDs), 24 in-depth interviews (IDIs), and 21 key informant interviews (KIIs). Participants included pregnant and breastfeeding women, healthcare workers, and community stakeholders, selected purposively. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis using Nvivo version 12 software guided by the Social Ecological Model. Results HIV stigma was pervasive, expressed through gossip, discrimination, secrecy, and moral judgment, shaping disclosure and access to care. COVID-19–related fear intensified social isolation, movement restrictions, and unintended disclosure of HIV status. The coexistence of both conditions created layered stigma that disrupted antenatal attendance, ART adherence, and household relationships. Despite these barriers, participants demonstrated resilience driven by child protection and survival. Coping strategies included discreet ART delivery, peer support, telehealth communication, and community sensitization. Trust in healthcare workers and confidentiality were central to service utilization. Conclusions Intersecting HIV and COVID-19 stigma and fear appeared to contribute to barriers in maternal health-seeking among women in Uganda. These influences may be reduced through targeted approaches such as confidential service delivery, peer-led support, and community education. Integrating stigma-sensitive practices into maternal and HIV care services could help strengthen trust, support service use, and improve maternal health outcomes during concurrent public health challenges.