Irrational fears about AIDS and negative attitudes towards people living with and who are at risk for HIV persist almost four decades into the global HIV pandemic. The consequences of these stigmatizing fears and attitudes negatively impact the global AIDS response and deny millions of people the human right to health.
Left untreated, HIV remains a deadly infectious disease. Almost 1 million people worldwide died of AIDS-related illnesses in 2017. This figure is down by almost half from an all-time high in 2005, reflecting how HIV treatment is prolonging and improving the lives of people living with HIV and preventing onward transmission. However, when only 59 percent of diagnosed people living with HIV are on treatment, we must address stigma as a barrier to getting people tested and treated.
Slaying the stigma
Equally distressing, new HIV infections have been reduced by 47 percent since 1996. Yet, an estimated 1.8 million new HIV infections in 2017 is hardly cause for celebration. This public health failure is due, in part, to HIV- and identity-specific stigmas — race, gender and sexual orientation, for example — that create barriers to accessing and using combination HIV prevention. Stigma related to whether a person is a substance user or lives with a mental health disorder only exacerbates the situation.
There is evidence of stigma’s pervasive effects. A 2018 survey of HIV-negative people in 12 European countries found that 52 percent of Eastern Europeans and 24 percent of Western Europeans have negative attitudes about working with people living with HIV. Approximately 35 percent of people living with HIV who were surveyed in 2018 across 29 Fast-Track cities — those that have agreed to increase their AIDS responses — have experienced stigma in their communities within the past year. An HIV Stigma Index survey conducted in 50 countries from 2015-2017 determined that one in eight people living with HIV is being denied access to health services because of stigma. A 2017 survey of HIV-negative women in the United States indicated that more than 30 percent would feel ashamed to tell others they were on pre-exposure prophylaxis (PrEP) — a biomedical HIV prevention tool that reduces the chance of acquiring HIV.
We must adopt a human rights-based approach to ending AIDS as a public health threat by 2030. This approach must respect the inalienable rights of all people to equality, dignity, and health. Despite effective prevention and treatment, getting to zero new HIV infections and zero AIDS-related deaths is not possible if we do not end HIV-related stigma.
Dr. José M. Zuniga, President and CEO, International Association of Providers of AIDS Care, [email protected]