HIV/AIDS-related stigma is a complex concept that refers to prejudice, discrediting, and discrimination directed at persons perceived to have HIV or AIDS, as well as their partners, friends, family, and communities. The devaluation of people living or perceived to be living with HIV/AIDS can negatively affect HIV prevention and treatment.
Both HIV-positive and HIV-negative youth may experience multiple layers of stigma related to the aspects of their identities. For example, young men who have sex with men (MSM); lesbian, gay, bisexual, transgender, queer, and two-spirited (LGBTQ2S+) youth; and racial/ethnic minorities face stigma regardless of their HIV status. Individuals may also face stigma related to mental health, substance use, and socioeconomic status.
HIV stigma can influence youth health through various levels including individual, interpersonal, institutional, community, and policy.
HIV stigma at the individual level is often a response to social norms that disregard people living with HIV.
- Internalized stigma. Adolescents may feel shame, embarrassment, and/or guild related to their HIV status, gender identity, or sexuality.
- Fear and discomfort of status disclosure. Youth may worry that people around them will notice their HIV medications or see them accessing HIV or sexual health clinics. Sometimes when a young person shares their HIV status, it is assumed to be related to a behavior (same-sex contact, intravenous drug use) that may also be stigmatized, adding to fear and discomfort about disclosing.
- Low self-esteem and depressive symptoms. Stigma and its related stress may lead to feelings of low self-worth and harm mental health along with the overall well-being of adolescents.
Interpersonal (Family, Friends, Partners)
Stigma may be present in adolescents’ relationships with partners, friends, family, and their community.
- Judgments from others related to disclosure or status. Family, friends, partners, and others (teachers, employers, and colleagues) may express beliefs or use language that is stigmatizing. These biases may be explicit (the person is aware of their judgments) or implicit (the person may not be aware of their bias but it influences their actions).
- Partner rejection. Once youth share their status or discuss HIV with past or potential partners, they may face rejection or other negative reactions.
- Inadequate social support network. Peers and families may distance themselves from youth living or perceived to be living with HIV to avoid experiencing the same stigma they do. This rejection could be internalized as abandonment, causing someone to avoid seeking support.
Institutional (Schools, Colleges, After-School Programs, Workplaces)
At this level, stigma originates in organizations and institutions and can impact adolescent health.
- Limited discussion around sexual health. Stigma can arise when providers, educators, and other leaders do not discuss sexual health with youth. This is particularly an issue with LGBTQ2S+ youth who may not receive inclusive sex education.
- Negative attitudes or beliefs surrounding HIV. If people working at the institutional level have negative or uninformed attitudes and beliefs about HIV, it can manifest as a stigma in their interactions.
- Lack of culturally appropriate environments. Settings that do not make a person’s culture or background into consideration can yield a stigma that affects young people of various cultures and ethnicity, LGBTQ2S+ youth, and MSM.
Community: Social/Cultural Influences, Availability of Resources
Stigma at the community level can affect youth through social/cultural influences and availability of resources.
- Cultural norms and traditions. Social stigma around being HIV-positive can be intensified by attention being further drawn to an adolescent’s sexuality, gender identity, ethnicity, class, and culture. Traditional community norms, cultural/social standards, and gender roles can contribute to reinforcing stigma around HIV and leading youth to internalize it.
- Lack of HIV prevention services in broad health and community contexts. Many schools, businesses, detention facilities, churches, and other community organizations have not integrated discussion of HIV into their practices, a silence that can contribute to HIV stigma
Policy (Local, State, & Federal Laws)
Laws and policies at the local, state, and federal levels can contribute to HIV stigma.
- HIV stigma, incidence, and prevalence are associated with state policies related to discrimination and rights. Results from a National Alliance of State & Territorial AIDS Directors/National Coalition of STD Directors survey revealed higher levels of stigma in states without employee non-discrimination laws focused on sexual orientation and gender, in states without hate crimes laws, and in states not allowing for same-sex marriage or civil unions.
Working to end stigma and discrimination experienced by people with HIV/AIDS is a critical factor in stopping the epidemic.
Strategies to Reduce HIV/AIDS Stigma
- Help build youth people’s self-esteem by using youth development principles and proper leadership training
- Encourage youth to seek knowledge and tools to stay educated about HIV prevention, transmission, and care.
- Build peer support to protect against stigma.
- Promote the use of language regarding HIV that is appropriate, factual, and inoffensive.
- Teach those connected with youth about HIV transmission, care, and testing
- Integrate regular HIV testing into standard care practices.
- Collaborate between organizations to better serve adolescents.
- Encourage lawmakers to consider HIV stigma when deciding whether to support policies that could have an impact on youth living with HIV.
- Ensure youth living with HIV are aware of their rights related to privacy.