Exploring Resilience-Based Interventions to Overcome HIV-Related Stigma Experiences Among Rural Older Women Living with HIV in Zimbabwe

Abstract

This study examined how resilience-based interventions enable rural older women living with HIV in Zimbabwe to confront stigma and sustain their quality of life. Guided by the 4S framework of resilience resources planning (social support, coping strategies, sagacity, and solution-seeking), the research explored how women apply these dimensions to navigate challenging life events. A purposive sample of 17 women (those not living with a spouse or in a socially sanctioned relationship), aged 40–65, all on antiretroviral therapy and drawn from rural Matabeleland South Province, participated through in-depth interviews. Using Interpretive Phenomenological Analysis, four themes emerged: (1) Social Support and Social Networks as Foundations of Resilience, (2) Self-Efficacy and Coping Strategies in Managing Emotional Distress, (3) Spirituality and Sagacity as Sources of Strength and Meaning, and (4) Sense of Purpose and Solution-Seeking Behaviours. The findings highlight that resilience is actively mobilised through family ties, peer groups, and community initiatives, enabling women to adapt to socio-economic hardship and health-related barriers. This study concludes that empowerment strategies, especially community-based programmes focused on skills development and economic opportunities, are essential for enhancing resilience, reducing vulnerability, and improving health outcomes. Strengthening these resources not only equips women to manage HIV-related challenges but also contributes to sustainable development within their communities.

1. Introduction

Over the past two decades, resilience has emerged as a central construct in developmental science, gerontology, and mental health research, particularly in contexts of chronic illness and social adversity [1,2,3]. Resilience is widely understood as a dynamic capacity that enables individuals to withstand, adapt to, and recover from significant life challenges, rather than merely endure them. Contemporary scholarship emphasises that resilience extends beyond coping, encompassing psychological endurance, adaptive functioning, and the potential for growth despite sustained adversity [4,5,6]. In the context of health and ageing, resilience is increasingly recognised as a critical determinant of quality of life (QoL), especially for populations facing intersecting vulnerabilities such as poverty, gender inequality, and chronic disease [7,8].

For women living with HIV (WLHIVs) in rural sub-Saharan Africa, resilience is not an abstract construct but a lived necessity. In Zimbabwe, older rural women living with HIV experience layered adversities that include persistent HIV-related stigma and discrimination, economic precarity, caregiving burdens, and constrained access to healthcare services, especially for those women who have no co-residence with an intimate partner as a primary source of emotional, financial, and social support [8,9]. Ageing with HIV introduces additional challenges, as older women often navigate declining physical strength, cumulative stigma, and social invisibility, while simultaneously sustaining households and caring for ill family members in resource-limited settings [8]. These intersecting stressors significantly compromise QoL and heighten vulnerability to psychological distress, social exclusion, and economic insecurity.

At the same time, evidence increasingly shows that older women are not passive victims of adversity but active agents who draw on personal, relational, and community resources to sustain well-being [10]. Studies conducted in rural African contexts demonstrate that resilience among WLHIVs is shaped by access to social support, culturally grounded coping strategies, accumulated life wisdom, and problem-solving capacities developed over the life course [11]. Banyard and colleagues’ resilience perspective remains relevant in highlighting how individual strengths and resources facilitate positive adaptation, reduce disability, and preserve QoL in the face of enduring adversity [12]. For older women living with HIV, resilience is therefore best understood as a dynamic process rooted in lived experience, social roles, and structural constraints [9].

Resilience-based interventions have gained traction as promising approaches for addressing HIV-related stigma and psychosocial distress, particularly when they leverage individuals’ inherent capacities and community-embedded resources [13]. Such interventions emphasise strengths rather than deficits, recognising the value of social connectedness, adaptive coping, insight derived from lived experience, and proactive solution-seeking. Within rural settings, where formal welfare and mental health services are limited, women frequently rely on informal networks, indigenous knowledge systems, and reciprocal support structures to manage adversity [14,15]. These locally grounded strategies are especially salient for older women, whose resilience is often shaped by decades of navigating hardship, caregiving, and social responsibility [15].

This study conceptualises resilience through the 4S resilience resources planning tool, which comprises social support, coping strategies, sagacity (wisdom and insight), and solution-seeking. The 4S framework provides a structured yet flexible lens for examining how older rural women living with HIV mobilise internal and external resources to confront stigma, discrimination, economic instability, and health-related challenges. Previous research suggests that social support buffers the effects of HIV-related stigma, adaptive coping reduces psychological distress, wisdom enhances meaning-making, and solution-seeking fosters agency and problem-focused adaptation [16]. However, empirical evidence on how these resilience resources interact in the lives of older rural women living with HIV remains limited, particularly in the Zimbabwean context.

Moreover, while community-based and economic empowerment initiatives have shown potential to improve HIV outcomes and reduce vulnerability, resilience is increasingly understood as both an individual and collective process embedded within social, cultural, and economic systems [17,18]. Promoting resilience among rural older women living with HIV is therefore not solely about personal adaptation, but also about strengthening supportive environments that enable dignity, agency, and sustained well-being [18].

Despite growing recognition of resilience as a protective factor, it remains unclear how the 4S resilience resources planning tool can be operationalised to empower older rural women living with HIV to overcome HIV-related stigma and its cascading social and economic consequences. There is limited empirical insight into how these women experience, interpret, and deploy resilience resources in their daily lives, and how such resources can inform contextually grounded interventions.

Accordingly, the objective of this study is to explore resilience-based interventions for overcoming HIV-related stigma among older rural women living with HIV in Zimbabwe, using the 4S resilience resources planning tool to examine how social support, coping strategies, sagacity, and solution-seeking are mobilised to foster adaptation, dignity, and quality of life.

2. Materials and Methods

2.1. Research Design and Epistemological Positioning

This study adopted a qualitative interpretive phenomenological approach (IPA) to generate an in-depth understanding of how older rural women living with HIV experience, interpret, and mobilise resilience in the context of HIV-related stigma. IPA is particularly suited to this inquiry because it privileges lived experience, meaning making, and participants’ own interpretations of adversity and adaptation, rather than testing predefined hypotheses [19]. An inductive analytic orientation guided this study, allowing patterns of resilience to emerge from women’s narratives while being sensitively structured within an existing resilience framework.

2.2. Participants and Setting

A purposive sample of women living with HIV (n = 17) comprised single, divorced, and widowed women in the following proportions: five women were single, six were divorced, and six were widowed from rural Matabeleland South Province of Zimbabwe. Their ages ranged from 40 to 65 years old. These women were all on antiretroviral (ARV) therapy, permanently living in the rural villages of Matolokisi and Ezikwakweni, Mtshabezi, in Matabeleland South Province of Zimbabwe. Data saturation determined the sample size.

2.3. Rationale for the Inclusion of Women Not Living with a Spouse

All participants in this study were not living in a socially sanctioned spousal relationship at the time of the interviews and were categorised as single (never married), divorced, or widowed. The inclusion of women across these marital categories was both methodologically intentional and conceptually grounded.

First, in rural Zimbabwean contexts, marriage often functions as a key axis of social legitimacy, economic security, and protection from stigma, particularly for women. Older women living with HIV who are not in spousal relationships frequently experience heightened social scrutiny, moral judgement, and exclusion, making them especially vulnerable to HIV-related stigma [20]. By focusing on women outside formal marital unions, the study foregrounds a group whose resilience is often forged in the absence of socially endorsed support structures.

Second, although these women differed in marital trajectories, they shared a common structural condition: the absence of a co-resident intimate partner as a primary source of emotional, financial, and social support [21]. This commonality enabled the study to examine how resilience is constructed when women rely on non-spousal networks, internal resources, and community-based strategies to sustain well-being.

Third, from a phenomenological standpoint, the emphasis was not on marital status as a variable to be compared, but on how women made sense of resilience in the context of compounded loss, stigma, and ageing with HIV.

2.4. Framework-Guided Inductive Structuring of Data

This study employed a pre-existing resilience resource planning framework (the 4S framework), comprising social support, coping strategies, sagacity, and solution-seeking, as a sensitising and organising structure rather than a rigid analytical template. Importantly, the framework was not imposed deductively to test theory, nor was it expanded into new theoretical constructs. Instead, participants’ narratives were used to populate, nuance, and deepen the existing framework, thereby extending its empirical richness without altering its conceptual boundaries.

This approach aligns with interpretive phenomenology, in which theory supports interpretation rather than dominating it.

2.5. Stepwise Data Generation Procedure

To operationalise the framework in a manner consistent with inductive, experience-driven inquiry, data were generated through a five-step reflective process, guided by open-ended prompts.

Step 1: Revisiting Past Experiences of Resilience

Women were first invited to recall a recent lived experience in which they overcame a significant challenge. This step anchored the discussion in concrete, embodied experiences rather than abstract notions of resilience.

Example prompt: “Think about a time recently when you overcame a challenge or setback in your life. Please describe this difficulty.”

Step 2: Identifying Social Support Resources

Participants were then asked to identify individuals who provided emotional, informational, or practical support during the difficulty. This step highlighted non-spousal and community-based support systems that are critical in contexts of social marginalisation.

Example prompt: “Can you identify the people you called on for support?”

Step 3: Identifying Coping Strategies

Women reflected on how they managed negative emotions and thoughts associated with the challenge. This step captured both culturally embedded and personally meaningful coping practices.

Example prompt: “What strategies did you use to cope with negative thoughts and feelings?”

Step 4: Identifying Sagacity (Wisdom and Insight)

Participants were encouraged to articulate the forms of wisdom that helped them endure and rebound. Sagacity was understood as cumulative, culturally grounded insight shaped by age, experience, and tradition.

Example prompt: “What sagacity helped you bounce back from this difficulty?”

Step 5: Identifying Solution-Seeking Behaviours

Finally, women identified specific actions taken to address the problem, highlighting their agency and problem-focused adaptation, even in resource-constrained settings.

Example prompt: “What solution-seeking behaviours did you apply to actively deal with the problem?”

2.6. The 4S Resilience Resources Planning Framework

Through this stepwise process, participants’ accounts added depth, context, and lived meaning to each domain of the 4S framework, without generating new theoretical categories. The framework thus functioned as a structuring lens, while the knowledge produced remained grounded in women’s subjective experiences, consistent with the inductive logic of interpretive phenomenology.

The example below (

Table 1. Example of completed 4S Resilience Planning tool for one woman.

Resilience Domain	Participant’s Lived Experience
Challenge Experienced	After being gossiped about in the village following a clinic visit, the woman experienced shame, emotional distress, and fear of further stigma related to her HIV status.
Social Support	An older neighbour who was also living with HIV provided emotional reassurance; a church women’s group offered prayer and inclusion; her adult daughter encouraged her not to withdraw from community life.
Coping Strategies	Prayer and singing hymns when feeling overwhelmed; tending a small vegetable garden to calm her thoughts; caring for chickens as part of her daily routine, which gave her a sense of purpose; avoiding ruminative thinking by staying busy.
Sagacity (Wisdom and Insight)	“I have learned that people will always talk, but I must protect my heart.” A proverb remembered from her grandmother about endurance, a faith-based belief that suffering does not define one’s worth, and lessons learned from surviving past hardships, including widowhood and food shortages.
Solution-Seeking Behaviours	Choosing to attend clinic appointments early in the morning to reduce visibility; seeking advice from a community health worker; consciously limiting disclosure; joining a local support group for women living with HIV; and planning small income-generating activities to reduce dependency.

Source: Authors’ own creation.

) illustrates how one participant’s lived experience populated the resilience domains of the 4S framework. The content illustrates patterns observed across participants and reflects the rural Zimbabwean context. Data were collected via face-to-face in-depth interviews.

2.7. Rigour and Trustworthiness

The rigour of this qualitative study was ensured through established criteria for trustworthiness, namely, credibility, dependability, confirmability, and transferability, consistent with the standards of interpretive phenomenological inquiry and qualitative health research. Credibility was strengthened through prolonged engagement with participants and through a data generation process that privileged women’s lived experiences of stigma and resilience. The interpretive phenomenological approach, combined with a structured, stepwise reflective procedure, enabled participants to articulate resilience in their own words through rich, experience-near accounts. Iterative questioning and probing enhanced clarity of meaning, while the systematic use of verbatim quotations ensured that interpretations remained firmly grounded in participants’ narratives and allowed for cross-checking of emerging interpretations for consistency and resonance. Dependability was supported by a transparent, systematic audit trail that documented recruitment, data generation, analytical decisions, and the application of the five-step 4S resilience resources planning procedure. This framework was applied consistently across participants, ensuring procedural coherence while retaining flexibility for individual life stories. Analytical decisions were explicitly recorded, demonstrating a traceable and deliberate process through which findings emerged. Confirmability was enhanced through ongoing reflexive memo-writing, whereby researchers critically examined the influence of their positionalities, prior knowledge of HIV and stigma, and familiarity with resilience theory. The 4S framework was used as an organising and sensitising structure rather than a theory-testing template, allowing participants’ narratives to populate and nuance the framework without interpretive imposition. Transferability was supported through detailed description of the rural context, participants’ social circumstances, and structural conditions such as ageing, HIV-related stigma, and absence of spousal support, enabling readers to assess the relevance of findings to similar populations and settings, particularly among older women living with HIV in resource-constrained contexts.

2.8. Ethical Considerations

The research ethics committee of the Medical Research Council of Zimbabwe (MRCZ) (MRCZ/A/2398/1) approved this study. The participants consented to this study, and their autonomy was respected as they were informed and assured of the confidentiality of the data they provided and their right to discontinue the interviews at any time without penalty. The researchers de-identified the data for analysis. The researchers also granted them the liberty to speak in their Ndebele language if they preferred; however, all participants preferred English.

2.9. Data Analysis

The researchers systematically analysed the data by (1) immersing themselves in the data and reading and rereading the narratives, (2) observing and commenting by scripting any emerging themes, (3) applying in-depth inductive qualitative analysis, and (4) generating initial codes. Final themes were constructed utilising the interpretive phenomenological analysis by Van Manen [19]. To ensure the reliability of interpretations, a collaborator created a summary list of themes from the margin notes and developed emergent themes using the transcripts. Differences were resolved through discussion to reach a consensus.

3. Results

The 4S resilience resources planning framework (social support, strategies for coping, sagacity, and solution-seeking) provided a coherent structure for organising women’s lived experiences of resilience in the face of HIV-related stigma and adversity. Analysis revealed four interrelated themes that reflect how older rural women living with HIV in Zimbabwe mobilised resilience resources during challenging life events: (1) social support and social networks, (2) self-efficacy and coping strategies, (3) spirituality and sagacity, and (4) a sense of purpose and solution-seeking. While analytically distinct, these themes were deeply interconnected in women’s narratives and collectively shaped pathways to well-being.

3.1. Theme 1: Social Support and Social Networks as Foundations of Resilience

Social support emerged as a central resilience resource that enabled women to withstand and recover from experiences of HIV-related stigma. In the absence of spousal relationships, participants relied on informal and non-marital social networks, including adult children, neighbours, church groups, and peers living with HIV.

Women described how these relationships provided emotional reassurance and a sense of belonging, particularly during moments of social rejection or internalised shame. One woman reflected as follows:

A 52-year-old woman, while reflecting on her past sources of resilience, recalled leaning on her neighbours for support. She said that most of her significant others in her village had deserted and gossiped about her because of her HIV-positive status, but then, her neighbour assured her that she was not alone, as they were also labelled.

“When people in the village started gossiping about me, I felt very small. But when I spoke to my neighbour, she reminded me that I am not alone. She said, ‘We are many like you, and we are still standing.’ That gave me strength.”

(Respondent # 04, Never married, 52 years)

Peer support from others living with HIV was especially meaningful, as it created spaces of understanding free from judgement:

“At the support group, I don’t have to explain myself. They already know. We laugh, we cry, and we encourage each other. That place helps me breathe.”

(Respondent # 20, Divorced, 61 years)

However, social support was not indiscriminate. Women actively curated their networks, distancing themselves from individuals who perpetuated stigma:

“I learned that not everyone deserves to hear my story. I choose whom I sit with and whom I talk to, so that my heart is protected.”

(Respondent # 10, Widowed, 59 years)

3.2. Theme 2: Self-Efficacy and Coping Strategies in Managing Emotional Distress

Coping strategies functioned as critical internal resources through which women regulated emotional distress associated with stigma, illness, and ageing. Participants described a range of emotion-focused and behavioural strategies that helped them manage fear, sadness, and anxiety.

Engaging in daily routines and productive activities fostered a sense of self-efficacy and control:

“When my thoughts become heavy and scattered, I go to my garden. As I dig, my mind becomes lighter. I remind myself that I am still useful.”

(Respondent # 02, Widowed, 56 years)

Spiritual and reflective practices also played a key role in emotional regulation:

“Sometimes I cry when I am alone, but after praying and singing, I feel calm again. I tell myself that tomorrow I will wake up and continue.”

(Respondent # 13, Divorced, 63 years)

Keeping busy was often described as a deliberate strategy to prevent negative thoughts from taking hold:

“If I sit and think too much, its pain after pain, my heart becomes painful. So, I make sure my day is full by occupying myself with cleaning, feeding the chickens, and helping others.”

(Respondent # 16, Single, 58 years)

3.3. Theme 3: Spirituality and Sagacity as Sources of Strength and Meaning

Sagacity, as wisdom gained through life experience, emerged as a deeply embedded resilience resource, closely intertwined with spirituality, cultural knowledge, and moral insight. Women drew on faith, proverbs, songs, and memories of past hardships to interpret their experiences and sustain hope.

Spiritual beliefs helped women reframe stigma and illness in ways that preserved dignity:

“God knows my life better than people do. Even if they judge me, I know that I am still worthy.”

(Respondent # 11, Widowed, 52 years)

Cultural wisdom and teachings passed down through generations also guided emotional endurance:

“My grandmother used to say, ‘A woman bends, but she does not break.’ When I remember that, I know I can survive this too.”

(Respondent # 12, Single, 49 years)

Women frequently situated their current struggles within a broader life narrative of survival:

“I have lost my husband, I have raised children alone, and I have faced hunger before. This illness is another mountain, but I have climbed many already.”

(Respondent # 17, Divorced, 64 years)

3.4. Theme 4: Sense of Purpose and Solution-Seeking Behaviours

Solution-seeking behaviours reflected women’s agency and determination to actively address challenges related to HIV-related stigma, health, and livelihoods. Rather than remaining passive, participants described practical actions taken to protect themselves and improve their circumstances. Women adopted strategic approaches to managing stigma in public spaces:

“I go to the clinic very early so that people do not see me. That way, I get my treatment and return home with peace.”

(Respondent # 05, Single, 40 years)

Seeking information and assistance was another important strategy:

“When I did not understand my treatment, I asked the nurse to explain again. I told myself that my life is important.”

(Respondent # 07, Widowed, 47 years)

A strong sense of purpose underpinned these solution-seeking behaviours, particularly caregiving responsibilities:

“My grandchildren depend on me. Even when I feel tired, I must stand up. They give me a reason to keep going.”

(Respondent # 09, Divorced, 60 years)

Integrating the 4S: Resilience as a Dynamic and Interconnected Process

Across narratives, the four resilience resources were deeply interconnected. Social support reinforced coping capacity; coping created space for reflection and sagacity; sagacity informed purposeful action; and successful solution-seeking strengthened confidence and social engagement. Together, these resources enabled women to mitigate the psychological and social impacts of HIV-related stigma and sustain well-being over time.

Variations in Resilience Strategies Across Marital Categories

Women’s narratives revealed a shared repertoire of resilience strategies, expressed through endurance, autonomy, and self-reliance. While these strategies were common across marital categories, subtle differences in emphasis emerged, reflecting the social positioning and lived experiences of widowed, divorced, and never-married women.

Widowed Women: Endurance and Moral Respectability

Widowed participants’ accounts emphasised perseverance and moral respectability, positioning resilience as a continuation of the marital bond and its social meaning. One widow explained the following:

“It’s what we built together that matters, as my strength comes from knowing I honor it. Surely, I carry his memory with dignity,”

(Respondent # 08, Widowed, 56 years)

while another affirmed the following:

“God is for everyone. He has not abandoned me, and so I keep on reminding myself that at least I have God. Faith keeps me steady, so that when I feel alone, I turn to the Bible.”

(Respondent # 10, Widowed, 59 years)

These reflections highlight the moral weight of perseverance, as captured in the following statement:

“Respectability matters to me for I don’t want to appear as broken but to be seen as someone who perseveres.”

(Respondent # 02, Widowed, 56 years)

Divorced Women: Autonomy and Boundary-Setting

Divorced women’s accounts underscored resilience as an active reclamation of agency. One participant noted the following:

“I had to choose myself in order to survive. So, for me, leaving was survival and the only way forward,”

(Respondent # 14, Divorced, 50 years)

While another asserted that

“I distaste Gossip, it can’t define me. One has to set boundaries and walk away from toxic voices.”

(Respondent # 15, Divorced, 59 years)

Such reflections reveal resilience as a process of self-definition and protection, exemplified in the following statement:

“As for me, I usually distance myself from the stigma because it’s not my shame to carry, but for the one who is stigmatizing; I refuse to carry shame that isn’t mine.”

(Respondent # 20, Divorced, 61 years)

Never-Married Women: Self-Reliance and Community Belonging

The single women’s accounts reframed resilience as both individual independence and collective solidarity. One explained that

“I stand on my own feet. I can’t rely on a man. I have my own things, my own chicken business. I can provide for myself,”

(Respondent # 01, Single, 41 years)

While another affirmed that

“My community is my family, belonging here gives me strength. We need to build our support through belonging because together we create the family we choose.”

(Respondent # 03, Single, 43 years)

Collective Repertoire of Resilience Strategies

All three groups drew from a shared repertoire of resilience strategies. The differences represent variations in emphasis rather than distinct typologies.

4. Discussion

This study explored how resilience resources help rural older women living with HIV in Zimbabwe navigate and overcome HIV-related stigma, using an interpretive phenomenological approach and structuring findings around the 4S resilience resources planning tool, including social support, coping strategies, sagacity, and solution-seeking. The results demonstrate that resilience is not a static personality trait but a dynamic, socially embedded process that mediates the impact of stigma on psychological and social well-being. These findings align with contemporary research showing that resilience can buffer the negative effects of HIV stigma and improve quality of life among older adults living with HIV [5,22], thereby underscoring the value of resilience-based interventions in stigma reduction.

Resilience as a Buffer Against HIV Stigma

Consistent with prior evidence, our findings highlight that resilience resources are inversely related to the deleterious effects of HIV stigma. In a study of older adults living with HIV in rural Namibia, resilience was negatively associated with depressive symptoms, highlighting its protective role in psychosocial outcomes amidst stigma [22]. Similarly, our participants described how social support and internally developed coping strategies helped them maintain emotional equilibrium and a sense of self amidst community judgement and gossip. This finding aligns with broader research that posits social support as a determinant of resilience and a protective factor against HIV-related stress, as observed in studies by Cong and colleagues, who demonstrated that resilience mediates stress outcomes through moderated mediation models [16].

Importantly, our findings extend the literature by showing how multi-layered resources, from relational networks to personal wisdom, interactively support resilience. Older women in this study did not rely on single strategies; rather, they mobilised interwoven resources that reduced the intensity and internalisation of stigma. This affirms recent studies suggesting that multi-component resilience, which encompasses social, cognitive, and behavioural elements, is crucial for sustaining well-being in the context of HIV stigma [13].

The Centrality of Social Support and Community Linkages

The primacy of social support in mediating stigma experiences among participants resonates with studies showing that community and relational ties are core resilience resources for people living with HIV. Systematic evidence from sub-Saharan Africa supports the effectiveness of community-based interventions in reducing HIV stigma and promoting psychosocial well-being, particularly when people living with HIV are both implementers and beneficiaries within their communities [23].

The women’s narratives of binding with church groups, peer networks, and neighbours echo research on relational resilience in HIV contexts. These forms of support not only provided emotional sustenance but also contributed to a sense of collective identity and solidarity, which research suggests can challenge stigmatising norms and reduce self-stigma [24,25]. Unlike interventions that target individuals in isolation, the informal social networks described in this study reflect organically sustained resilience resources that align with community-centred stigma reduction approaches.

Coping Strategies and Self-Efficacy

Participants’ deployment of culturally grounded coping strategies, such as engaging in agricultural tasks, routine maintenance, prayer, and social participation, mirrors findings from rural South African contexts, where older adults use selective disclosure, chronic illness comparison, and identity assertions to resist stigma and maintain engagement with health services [26]. These strategies illustrate how resilience is enacted through everyday life activities that confer agency, continuity, and purpose despite adversity.

Our findings further highlight that self-efficacy and behavioural coping are linked to agency. Women’s descriptions of “keeping busy” or structuring their days as a means to regulate emotional distress resonate with research showing that active coping and self-management behaviours contribute to resilience and enable people living with HIV to navigate internalised and anticipated stigma [27].

Sagacity and Spirituality as Meaning-Making Resources

The role of sagacity is drawn from personal wisdom, folklore, cultural proverbs, and spiritual beliefs, which adds depth to the understanding of resilience among older women [28]. Spirituality has long been recognised as a resource that facilitates meaning-making in the face of chronic illness and adversity [29]. Our findings show that sagacity not only anchored emotional resilience but also enabled women to reframe stigmatising narratives, affirm dignity, and sustain hope. This aligns with resilience scholarship that emphasises meaning-focused coping and identity resilience as buffers against chronic stressors [30].

Solution-Seeking and Purpose-Driven Agency

Solution-seeking behaviours reflect a proactive approach to engaging with adversity rather than passive endurance [31]. Participants’ strategic decisions around clinic attendance, disclosure choices, and livelihood actions demonstrate purposive agency, which is increasingly recognised in resilience research as vital for mitigating the effects of HIV stigma. Across settings, interventions that enhance problem-solving skills, assertiveness, and intentional action have been shown to strengthen resilience capacities and improve psychosocial outcomes. [32,33].

In our study, women’s sense of purpose is grounded in caregiving roles and community participation, which further motivates resilience processes. This supports the literature proposing that meaning and engagement are critical components of resilience in chronic illness contexts, enabling individuals to maintain continuity and coherence in their life trajectories despite stigma and marginalisation [34].

Similarities and Differences in Resilience Strategies Across Marital Categories

Analysis revealed that while women’s biographical pathways into singleness, divorce, or widowhood differed, the resilience strategies they employed were largely convergent, shaped more by structural constraints and life stage than by marital history alone.

Across all three groups, women drew heavily on social support beyond intimate partnerships, including adult children, neighbours, church groups, and peer networks of other women living with HIV. They also employed emotion-focused and meaning-based coping strategies, such as prayer, singing, storytelling, engaging in farming activities, and caring for animals. On the other hand, their sagacity is derived from lived experience, including lessons learned from past hardship, cultural proverbs, and moral teachings transmitted across generations. These women also drew heavily on pragmatic, solution-seeking approaches, particularly in managing food insecurity, healthcare access, and disclosure decisions. However, subtle distinctions were evident, as widowed women often drew on narratives of endurance and moral respectability, emphasising faith, legacy, and perseverance. Again, divorced women more frequently articulated resilience through autonomy, boundary-setting, and deliberate distancing from stigmatising relationships. These never-married women tended to emphasise self-reliance and community belonging as compensatory sources of identity and support.

These differences did not constitute separate resilience typologies but rather variations in emphasis within a shared repertoire of strategies, reinforcing the appropriateness of analysing the group collectively while remaining attentive to nuance.

4.1. Implications for Resilience-Based Interventions

The current evidence underscores that interventions to reduce HIV stigma for older women should integrate social, emotional, cognitive, and practical resources. Community-based and peer-led models that build relational capital, enhance coping skills, and affirm identity resilience hold promise. Although systematic reviews indicate a need for more robust trials, emerging evidence suggests that multi-component approaches, including information sharing, counselling, and peer support, can reduce stigma and strengthen psychosocial well-being [23].

For rural older women living with HIV, interventions should be context-specific, culturally anchored, and structurally supportive. As noted by Ashburn and Warner [35], economic advancement reduces women’s vulnerability to HIV and increases their agency in making informed health decisions. Equally important is involving women in local decision—making processes, which fosters ownership of their health and cultivates supportive community systems that challenge cultural pressures [36]. Approaches that build on existing social networks, promote intergenerational solidarity, and mobilise community participation are likely to resonate with women’s lived experiences and enhance sustainability.

4.2. Limitations and Future Recommendations

A major strength of this study is its phenomenological grounding, which foregrounds the voices and agency of older rural women often marginalised in HIV research. However, generalisation beyond similar rural contexts should be cautious. Additionally, while linkages to broader African literature are valuable, there remains a need for more intervention studies that directly involve older populations in sub-Saharan Africa.

While this study offers important insights, several limitations should be acknowledged. First, the study was conducted among a specific group of older rural women living with HIV who were not in spousal relationships, which may limit the transferability of findings to women living with partners or to urban settings. However, this focus was intentional, as women without spousal support often experience heightened stigma and social vulnerability, making their resilience strategies particularly instructive.

Second, as with all qualitative and phenomenological research, the findings are based on self-reported experiences and retrospective accounts, which may be influenced by recall bias or social desirability [37]. Nevertheless, the depth of engagement, the use of reflective prompts, and the grounding of the analysis in participants’ narratives strengthen the credibility of the findings.

Third, although the 4S framework provided a useful organising structure, it may not capture all possible dimensions of resilience, particularly structural or macro-level factors such as policy environments, economic systems, or healthcare infrastructure. Future research could integrate the 4S framework with broader socio-ecological models to explore how individual resilience interacts with structural conditions.

Future studies should consider longitudinal designs to examine how resilience resources evolve over time as women age with HIV, particularly in relation to changing health status, caregiving responsibilities, and social roles. There is also a need for intervention-based research that operationalises the 4S framework in community or clinical settings and evaluates its effectiveness in reducing stigma and improving well-being outcomes.

Finally, future research should include comparative and participatory approaches, engaging older women as co-researchers in the design and evaluation of resilience-based interventions. Such approaches would not only enhance contextual relevance but also align with the ethical imperative to recognise older women living with HIV as knowledge holders and active agents in shaping responses to stigma.

5. Conclusions

This study contributes to the growing literature on stigma and resilience by demonstrating how multifaceted resilience resources support rural older women living with HIV in overcoming HIV-related stigma. By linking social support, coping strategies, sagacity, and solution-seeking to well-being outcomes, it provides a nuanced picture of resilience as both a process and an intervention target. These insights can inform culturally relevant stigma reduction strategies that enhance dignity, agency, and quality of life for older women living with HIV in rural Zimbabwe and similar settings.

Importantly, the findings suggest that stigma reduction efforts should not focus solely on changing community attitudes, but also on strengthening women’s internal and relational capacities to resist, reinterpret, and respond to stigma. Interventions that foster purpose, agency, and social connectedness are likely to be particularly effective for older women whose resilience is shaped by cumulative life experience and caregiving roles. By centring women’s lived experiences and knowledge, resilience-based approaches can contribute to more inclusive, age-responsive, and gender-sensitive HIV programming.