Stigma monitoring, interventions, and a way forward
By Dr Timothy Broady, Senior Research Fellow, Centre for Social Research in Health
At the 17th International AIDS Conference (August 2008), the United Nations General Secretary stated that “stigma remains the single most important barrier to public action”. More than 15 years later, HIV-related stigma and discrimination remains a significant issue worldwide. In Australia, the national HIV strategy contains a clear objective to eliminate the negative effects of stigma and discrimination on people’s health.
Since 2016, the Stigma Indicators Monitoring Project has monitored the experience of stigma among people living with HIV and other priority population groups identified in the national strategies, as well as the expression of stigma towards these groups by the general public and health care workers.
Findings from this project have consistently highlighted that stigma is commonly experienced by people living with HIV, though this decreased from 74% of those surveyed in 2016 to 37% in 2022. Importantly, 44% of participants in 2022 reported not disclosing their HIV status to health care workers in order to avoid being treated negatively and 26% had delayed accessing health care, highlighting the significant impact of expecting to experience stigma and discrimination.
Stigma related to behaviours associated with a risk of HIV transmission have varied over time. For example, the proportion of men who have sex with men reporting any stigma or discrimination within the past year has fluctuated between 52%-82%, with stigma being most commonly reported in 2018 (coinciding with the Australian Marriage Equality postal survey). In 2023, 77% of people who inject drugs reported any stigma within the past year, and this has remained stable since 2018. Equally concerning as these high rates of experienced stigma, the most recent monitoring data shows that 50% of a sample of over 2000 Australians would behave negative towards people living with HIV, 40% would behave negatively because of someone’s sexual orientation, and 79% would behave negatively towards people who inject drugs.
Building on this monitoring work, the real question is: “What can be done to address stigma and discrimination?”. Recent work conducted by the Centre for Social Research in Health has drawn on international evidence and trialled a range of approaches to stigma reduction interventions. These interventions have utilised different approaches, including positive contact with individuals from stigmatised groups, social norms-based interventions, educational approaches, and addressing structural drivers of stigma. Supporting previous literature, most of these intervention approaches have demonstrated immediate positive effects. A key issue, however, is that many positive changes dissipate over time. The effectiveness of stigma interventions also varies according to people’s social values, with more socially conservative participants reporting the least attitudinal change.
To move forward in attempting to meaningfully reduce stigmatising experiences for affected groups and individuals, there is a clear need for ongoing investment in stigma reduction, using a range of different approaches. One suggestion is to implement a “universal precautions” approach to reducing stigma – that is, developing inclusive and supporting environments for all people, rather than focusing on stigma directed to any specific condition, behaviour, or identity. Any intervention approach must also consider the possibility of unintended consequences, with segmentation of messaging according to targeted audiences (including those with more conservative social views who may be more resistant to change).
The Centre for Social Research in Health will be hosting the inaugural “Tackling Stigma” conference in November 2024. This conference will encourage conversation and debate regarding issues that contribute to stigma and will promote discussions of novel strategies to overcome stigma as a barrier to healthcare.
For more information on the Tackling Stigma conference, please visit the conference website: https://www.unsw.edu.au/research/csrh/tackling-stigma
More information regarding the research referred to in this blog can be found at the following websites:
Stigma Research Stream | Centre for Social Research in Health – UNSW Sydney
Annual Report of Trends in Behaviour | Centre for Social Research in Health – UNSW Sydney
Published: March 2024