Stigma occurs when a person or a group of people are devalued because they are associated with a certain disease, behavior or practice. And like a one-two punch, those who are stigmatized often experience discrimination in some fashion. The effects of both can be even worse for groups who already are marginalized because of their gender, sexuality, ethnicity or substance abuse.
Regardless of context, the causes and consequences of stigma and discrimination are the same worldwide. It happens whether you are a woman with HIV or a man who injects drugs; whether you live in a rural or urban community; or if you live in countries as culturally different as Vietnam and Zambia.
Often, those who stigmatize people living with HIV falsely believe that the virus is highly contagious and that they could easily become infected. When that happens, others start to view people with HIV as a threat, and as a result, many become isolated – within their homes, in public or at their workplaces. People living with HIV are further stigmatized by others’ assumptions about their moral integrity – such as the belief that they became infected with HIV because they chose to take part in risky behavior. And because in many countries women are held to a different moral standard than men, they often are disproportionately blamed for HIV in their communities.
In the end, stigma and discrimination undermine global efforts to prevent HIV transmission and provide care and treatment services to people living with HIV. Among marginalized, or ‘key populations’ most at risk of HIV – like adolescent girls, men who have sex with men, sex workers or people who inject drugs – stigma and discrimination impede access to and uptake in HIV services. In some settings, the LGBTI community may fear being arrested if they are identified while accessing health care services, due to laws that criminalize same sex behavior. In other settings, discriminatory policies and laws may increase the risk of HIV infection. For example, laws prohibiting people from carrying more than one syringe at a time interfere with harm reduction efforts to ensure access to safe injection equipment.
Stigma and discrimination also hinder people living with HIV from telling their partners about their status, for fear of being abandoned, ostracized or physically abused. Additionally, HIV-related stigma affects people’s ability to earn a living, making it even more difficult for people living with HIV to lift themselves out of poverty. Ultimately, stigma and discrimination infringe upon people’s basic human rights. Efforts to reduce and mitigate them are critical to achieve global public health goals.
Jennifer Abrahamson writes about Joyce, an 18 year-old girl
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For more than a decade, ICRW has analyzed data surrounding, and taken action on, stigma and discrimination toward people living with HIV. We have found that the key causes of stigma, its impact and its consequences have many more similarities than differences across contexts.
ICRW has developed evidence-based tools designed to help communities reduce stigma and discrimination, with a particular focus on key populations at higher risk of contracting the virus, including sex workers, migrant populations, injecting drug users, men who have sex with men and adolescent girls. From local organizations to international institutions, ICRW draws from research and program experience to advise global entities on how to integrate stigma-reduction strategies into existing HIV and AIDS programs and policies.
ICRW has been influential in developing standardized measures of stigma and discrimination for global reporting and evaluation purposes over the last decade. ICRW researchers led a collaborative global process with program implementers, evaluation experts, academics and people living with HIV to create a universal set of indicators to provide a rigorous comparison of data across diverse settings and to increase investments to reduce stigma. We are also continuing this work with the development and validation of parallel measures of stigma for use in biomedical trials.
We are actively engaged in research to understand how stigma influences the success of biomedical prevention technologies, such as Universal HIV Testing and Treatment among reproductive aged adults and pre-exposure prophylaxis among young women in sub-Saharan Africa. ICRW is developing and testing interventions to address the needs and stigma-related concerns of young women living with HIV in sub-Saharan Africa to ensure a healthy transition to adulthood.
Finally, ICRW engages more broadly on research related to human rights and HIV, including conducting systematic reviews of the latest evidence, evaluations of access to justice interventions and developing conceptual frameworks to inform more rigorous evaluation of human rights programs in the context of HIV.