HIV-related stigmaHeath Paynter
By HOLA (HIV Online Learning Australia)
HOLA (HIV Online Learning Australia), a program of Health Equity Matters and NAPWHA (National Association of People with HIV Australia), recently published a paper on HIV-related stigma interventions by Dr Dean Murphy. The paper provides an explanation of some HIV stigma definitions, an overview of the theory and concepts related to stigma, and various approaches used in the development of HIV-related stigma interventions, as well as an overview of how HIV-related stigma is measured. This blog provides a summary of the paper.
Stigma is often described as a form of marginalisation and social devaluation, and affects a person’s mental and physical health.
Stigma is a significant issue for people living with HIV. It is also a barrier for HIV testing, prevention and treatment.
Stigma leads to discrimination, shame and making someone feel excluded. It involves prejudice and discrimination. Often people living with HIV feel stigmatised because of their positive HIV status.
Stigma can be expressed or experienced. Expressed stigma (or enacted stigma) refers to the practices through which members of certain groups prejudice, or discriminate against others, for example on the basis of their positive HIV status. Experienced stigma is where individuals or groups experience discrimination, devaluing, or prejudice, which can be the result of stigma expressed/enacted by others, through perceived or felt stigma, or self-stigma (internalised negative attitudes).
An example of expressed stigma could be when person says something negative or degrading about a person or people living with HIV. Experienced stigma could be when a person feels devalued as a result of hearing such degrading comments about their health status.
One complication in addressing HIV-related stigma is that it can come from within communities as well as from outside. An example of stigma within a community is when men who have sex with men who use dating apps can judge or exclude others based on their HIV status.
Dr Murphy’s paper categorises a range of possible approaches to address HIV-related stigma and provides examples of interventions using these approaches from both Australia and overseas. One approach is through education and awareness to help to increase knowledge and reduce misinformation and myths about HIV. Other ways are through creating connections with affected groups, providing a human face to HIV while building empathy among the community with people living with HIV.
Improving language and communication is another way to reduce stigma, such as through media training for journalists and how they present stories in the press about HIV. Promoting alliances to support people living with HIV in the community such as through relationships, sexual encounters, friendships and family is another. Building resilience to address deeply held negative beliefs that underly HIV-related internalised stigma and reduce stigma experienced by people living with HIV, was also identified.
Other approaches discussed in the paper included, improving systems, standards and guidelines within services and the health system (such as integrating health services, staff training, and hiring staff who represent the communities from which clients are drawn), as well as advocating for structural reform to change social and political structures that lead to stigma (including campaigns to change laws and policies).
Given the various approaches to address HIV-related stigma, Dr Muphy’s paper recommends that developers of interventions should therefore consider what they are seeking to achieve, the socio-ecological level (individual, interpersonal, organisational, community, public policy) being targeted, and the domain they are seeking to act on (drivers, facilitators, or manifestations) when they design a stigma activity.
You can read the full paper here: HIV-related stigma interventions.