Health, Stigma, and Infectious Disease Management in the Mbarara Main Prison: A Qualitative Study of Staff and Incarcerated People

The current qualitative pilot study drew on 38 semi-structured interviews conducted in January 2025 with Uganda Prisons Service (USP) staff (n = 16) and incarcerated men (n = 22). Interviews explored experiences of HIV, stigma, prevention, treatment adherence, and health system capacity. Data were analyzed separately for staff and prisoners using an inductive, semi-grounded thematic approach supported by NVivo, with multiple coders and integrated codebooks to enhance analytic rigor. Participants widely reported overt HIV-related stigma within the prison had diminished over time. Both staff and incarcerated individuals described a zero-tolerance approach to discrimination, routine access to HIV testing and antiretroviral therapy, peer support, and, in some cases, enhanced nutritional provision for people living with HIV. Education and “sensitization” were consistently identified as central to stigma reduction and treatment adherence, with strong support for peer-based counseling models. However, stigma persisted indirectly through associations between HIV and homosexuality, which remains criminalized and highly stigmatized. Despite severe structural constraints, Mbarara Main Prison has fostered an institutional culture that actively discourages HIV-related stigma.