- Stigma reduces individual health, well-being and quality of life.
- Stigma undermines elimination of HIV transmission targets via direct impacts at each stage of the prevention and care cascade.
- Australian policy frameworks contain a strong commitment to stigma reduction targets.
- Investment in research into methods of stigma reduction is needed to guide interventions in Australia.
- Involvement of the affected community in stigma reduction efforts is essential.
- Issues of intersecting or layered stigma require additional attention.
New targets have been formulated, guided by existing data from the Stigma Indicators Monitoring Program.19 Population-specific targets are proposed as follows.
- >95% of PLHIV report no stigma in the last 12 months.
- >95% of PLHIV report health care workers do not treat them negatively/differently in the last 12 months.
- 75% of PLHIV reporting good quality of life.
- >95% of HIV-negative MSM report no stigma in the last 12 months.
Health care workers
- >95% of health care workers indicate they would not behave negatively towards PLHIV.
- >95% indicate they would not behave negatively towards a person because of their HIV status.
- Involve affected communities in stigma reduction. Best practice interventions for stigma reduction place people affected by stigma at the core of the response. Hence, direct and deep community involvement at each stage is essential for achieving stigma reduction.
- Invest in research designed to develop precise measures of layered stigma. Issues of intersectional or layered stigma associated with multiple stigmatised identities require specific attention. These issues are particularly relevant for people living with (or at risk of) HIV who are Aboriginal or Torres Strait Islanders or from culturally and linguistically diverse backgrounds (especially men who have recently arrived from countries where HIV and homosexuality stigma is higher than in Australia). Layered stigma is also a consideration for people who are multiply labelled because of their HIV status and other practices/identities which attract stigma (such as sexual orientation, injecting drug use, sex work or co-occurring health conditions). We currently lack measures of stigma precise enough to permit intersectional analysis of its experience or expression.
- Increase investment in stigma reduction programs. There is an urgent need for increased investment in stigma reduction programs, including foundational research into ways to expand the evidence base and monitoring and evaluation of outcomes.
- Advocate for recognition of the importance of stigma in the HIV epidemic and general health. Reducing stigma will require a focused effort across individual, interpersonal, organisational and structural levels. This will require a commitment from health systems, in particular, to recognise stigma undermines the principles of quality and equity of care and undermines efforts to end HIV.