Detecting HIV-Related Stigma in Clinical Narratives Using Large Language Models
Authors: Ziyi Chen, Yasir Khan, Mengyuan Zhang, Cheng Peng, Mengxian Lyu, Yiyang Liu, Krishna Vaddiparti, Robert L Cook, +2 more
Organizations: Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA · Department of Epidemiology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA · Preston A. Wells, Jr. Center for Brain Tumor Therapy, Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, USA
Human immunodeficiency virus (HIV)-related stigma is a critical psychosocial determinant of health for people living with HIV (PLWH), influencing mental health, engagement in care, and treatment outcomes. Although stigma-related experiences are documented in clinical narratives, there is a lack of off-the-shelf tools to extract and categorize them. This study aims to develop a large language model (LLM)-based tool for identifying HIV stigma from clinical notes. We identified clinical notes from PLWH receiving care at the University of Florida (UF) Health between 2012 and 2022. Candidate sentences were identified using expert-curated stigma-related keywords and iteratively expanded via clinical word embeddings. A total of 1,332 sentences were manually annotated across four stigma subscales: Concern with Public Attitudes, Disclosure Concerns, Negative Self-Image, and Personalized Stigma. We compared GatorTron-large and BERT as encoder-based baselines, and GPT-OSS-20B, LLaMA-8B, and MedGemma-27B as generative LLMs, under zero-shot and few-shot prompting. GatorTron-large achieved the best overall performance (Micro F1 = 0.62). Few-shot prompting substantially improved generative model performance, with 5-shot GPT-OSS-20B and LLaMA-8B achieving Micro-F1 scores of 0.57 and 0.59, respectively. Performance varied by stigma subscale, with Negative Self-Image showing the highest predictability and Personalized Stigma remaining the most challenging. Zero-shot generative inference exhibited non-trivial failure rates (up to 32%). This study develops the first practical NLP tool for identifying HIV stigma in clinical notes.
Mental health stigma has profoundly harmful impacts but its complexity makes it difficult to evaluate. Stigma may involve explicit derogation, but also subtler forms of blame, fear, paternalistic pity, social distancing, structural exclusion, and discrimination. We introduce a theory-grounded benchmark for automatic evaluation of mental health stigma in online communication, consisting of naturally occurring online news and social media text annotated with a fine-grained taxonomy of stigma across multiple mental health conditions. Our annotation framework comprises a binary stigma-detection task and a multi-level taxonomy covering (i) stigma mode, (ii) domain, and (iii) specific components of certain forms of stigma. We apply this framework to texts mentioning six mental health conditions and evaluate large language models alongside stigma-related classifiers for detecting sentiment, toxicity, and hate speech. Results show that mental health stigma is not well captured by models trained to detect these neighboring constructs, and that LLMs often overpredict stigma unless given explicit operational rules - mirroring the importance of decision rules in human annotation. We release the publicly available part of benchmark, annotations, prototypical exemplars of stigma and code at: https://github.com/jemimakang/mh_stigma.
Naomi Baes, Jemima Kang, Nick Haslam +4
Melbourne School of Psychological Sciences, The University of Melbourne · Department of General and Computational Linguistics, University of Tübingen · School of Computing and Information Systems, The University of Melbourne
Simulating patients with large language models (LLMs) is a promising tool for mental health training, but existing approaches fail to capture a key clinical reality: self-stigma. Patients experiencing self-stigma, the internalization of negative stereotypes, often exhibit context-sensitive resistance, such as avoidance, denial, or self-blame, which current models render as static or uniformly compliant behavior. To address this, we introduce a novel simulation framework grounded in the psychological 3A1H model of self-stigmatization. Our core innovation is the creation of a Stigmatized Self-Reflection (SSR) dataset, where we augment mental health dialogues with internal monologues that reflect stigma-aware reasoning. By fine-tuning LLMs with this data using a chain-of-thought approach, we train patient agents to dynamically adjust their level and expression of stigma based on conversational triggers. Evaluations demonstrate that our approach significantly outperforms specialized baselines, generating more authentic and situationally appropriate patient responses. This work provides a crucial step towards realistic stigma simulation for clinical training and empathetic dialogue systems.
Kunyao Lan, Bingrui Jin, Zichen Zhu +1
X-LANCE Lab, Dept. of Computer Science and Engineering MoE Key Lab of Artificial Intelligence, AI Institute Shanghai Jiao Tong University, China
While large language models (LLMs) are increasingly being explored for mental health applications, recent studies reveal that they can exhibit stigma toward individuals with psychological conditions. Existing evaluations of this stigma primarily rely on multiple-choice questions (MCQs), which fail to capture the biases embedded within the models' underlying logic. In this paper, we analyze the intermediate reasoning steps of LLMs to uncover hidden stigmatizing language and the internal rationales driving it. We leverage clinical expertise to categorize common patterns of stigmatizing language directed at individuals with psychological conditions and use this framework to identify and tag problematic statements in LLM reasoning. Furthermore, we rate the severity of these statements, distinguishing between overt prejudice and more subtle, less immediately harmful biases. To broaden the reasoning domain and capture a wider array of patterns, we also extend an existing mental health stigma benchmark by incorporating additional psychological conditions. Our findings demonstrate that evaluating model reasoning not only exposes substantially more stigma than traditional MCQ-based methods but also helps identify the flaws in the LLMs' logic and their understanding of mental health conditions.