Ongoing Stigma Remains a Major Obstacle in the Fight Against HIV | AIDS 2024

The stigma on those living with HIV remains as heavy of an issue today as it did when the virus first became widely known to the world in the early 1980s.

According to UNAIDS, 39.9 million people globally were living with HIV in 2023. Since the start of the epidemic, 42.3 million people have died from AIDS-related illnesses. HIV weakens the immune system and destroys blood cells that can fight off other infections and diseases

HIV-related stigma is unfortunately another negative affect that significantly impacts both individuals and society. At the 25th annual international AIDS Conference in Munich, Germany, a group of international experts discussed the impact of HIV-related stigma and discrimination on efforts to end the HIV pandemic as a public health threat by 2030.

The group also shared experiences and efforts to combat HIV-related stigma and discrimination.

Laura Ferguson, an associate professor of population and public health sciences at the University of Southern California, was one of the experts speaking during the virtual session today.

Ferguson shared that stigma, rooted in negative beliefs, feelings and attitudes toward people with HIV, often leads to internalized shame, guilt and fear of disclosure, resulting in depression, anxiety and social isolation.

Stigma is also built into laws and rules that make it a crime to expose others to HIV or engage in behaviors associated with it. This can worsen health disparities and prevents people from accessing services, leading to preventable deaths.

Ferguson added that stigma overlaps with other types of discrimination, such as racism, homophobia and transphobia, pushing already excluded groups even further to the edges of society.

“We know that without addressing HIV related stigma, we will not reach global HIV targets,” she said, referring to the 95-95-95 targets. These aim for 95% diagnosis, treatment, and viral suppression among people living with HIV, while the 10-10-10 targets focus on reducing stigma, inequalities in access to services and laws to support the overall HIV response, according to UNAIDS.

Florence Riako Anam, the co-executive director at the Global Network of People Living with HIV, shared her personal journey with HIV-related stigma during the presentation, emphasizing its significant impact on her life and the strength she built to overcome it.

Diagnosed in her mid-20s, Anam faced severe internal and external stigma, stemming from cultural narratives that depicted HIV as a fatal and shameful disease. This stigma led to her social isolation, depression and loss of employment.

She recalled the humiliation of being labeled "the girl who has AIDS" and the loneliness that followed, leading her to remove herself from social interactions and seclude herself completely.

To cope with these challenges, Anam turned to blogging, which connected her with a supportive community and eventually gave her the courage to share her story publicly.

She said this process was crucial for her healing, helping her overcome internalized stigma and showing how support groups provide essential advice and comfort for people living with HIV.

Similar to her blogging, Anam gave insight on the HIV Stigma Index, a tool developed by and for people living with HIV to document their experiences of stigma and discrimination.

This index has shaped policies, laws and programs aimed at reducing stigma and empowering those affected. The index's data, collected from over 30 countries, revealed that a significant proportion of respondents experienced internal stigma, which impacted their mental health and adherence to treatment.

Anam stressed the need for continued efforts to change societal narratives around HIV, promote understanding and support individuals in overcoming stigma.

With that being said, it's crucial to examine how stigma continues to impact various areas, including healthcare.

Nerine Rizk, a physician and assistant professor at the American University of Beirut, discussed the continuous stigma of HIV in healthcare.

Stigma, linked to gender identity, sexual orientation, drug use and sex work, affects access to and retention in care, another factor affecting efforts to meet targets by 2030.

Globally, only 71% of people living with HIV know their status, 67% are on treatment, and 83% of those on treatment achieve viral suppression. Focusing on the Middle East and North Africa (MENA) region, Rizk pointed out even lower rates: 67% know their status, 50% are on treatment and only 45% achieve viral suppression.

She identified two root causes of healthcare stigma: lack of knowledge among healthcare providers and transmission misconceptions.

These factors can be addressed through targeted interventions to replace myths with accurate information, Rizk added.

In healthcare, some examples of stigma include physical distancing, excessive precautions, denial of care, psychological abuse, ostracism and breaches of confidentiality, she said. This kind of stigma discourages folks from seeking testing, adhering to treatment and engaging in care.

"The damaging impact of HIV stigma on people living with HIV and populations at high risk is a major factor in hindering our progress to ending the epidemic and reaching zero transmissions,” Rizk concluded.