HIV Stigma

Ending the human immunodeficiency virus (HIV) pandemic requires understanding the role of stigma and discrimination in HIV transmission and care. Although advances in care have transformed HIV and other manifestations of HIV infection from a rapidly fatal illness of an unknown cause to a preventable and manageable illness, the pandemic continues. In order to end the pandemic, accelerated efforts to test, diagnose, treat, and prevent HIV infection are required. Despite advances in care and changes in societal attitudes, the pandemic of HIV stigma and discrimination also continues. HIV stigma and discrimination have multiple biopsychosocial determinants and contribute to HIV transmission, nonadherence to care, treatment cascade, and morbidity and mortality in persons with HIV. Stigma, discrimination, and fear may prevent persons with risk behaviors, such as unprotected sex and injection drug use, from getting tested, learning that they have HIV, or accessing care. Once diagnosed, stigma and fear of discrimination and rejection based on seropositivity prevent persons from disclosing HIV positive serostatus to family members, close friends, or even intimate partners. Some persons avoid access to HIV clinicians for fear of forced disclosure by the nature and setting of care or the antiretroviral medications prescribed. Multidimensional factors that magnify HIV stigma or AIDSism include sexual orientation and gender identity, use of injection drugs, ethnicity, poverty, psychiatric illness stigma, and homelessness. HIV stigma and discrimination have a profound impact on prevention, access to care, treatment with antiretrovirals, and retention in treatment throughout the life cycle and care continuum.