Stigma experienced by people living with HIV/AIDS

Abstract

HIV stigma represents a significant barrier to successful efforts to engage people living with HIV/AIDS (PLWHA) in services. In this Chapter, we discuss three approaches to better understanding HIV stigma experienced by PLWHA. First, we contextualize HIV stigma as a social process. Therefore, the ways that HIV stigma is expressed and experienced by PLWHA varies widely depending on sociocultural contexts. Understanding the structural and interpersonal drivers of HIV stigma within a particular social context is critical for intervening to reduce the stigma experienced by PLWHA. A second approach for understanding stigma reconceptualizes multiple stigmas that PLWHA may experience such as those associated with drug use, sex work, homosexuality, racial/ethnic minorities, and poverty. HIV stigma interacts with these other intersecting stigmas to shape the stigma-related experiences of PLWHA. Consequently, it may be impossible to intervene in HIV stigma without also addressing PLWHA's experience of intersecting stigmas. The third approach to understanding HIV stigma concentrates on the mechanisms of stigma experienced by PLWHA. HIV stigma mechanisms represent the ways that PLWHA respond to stigma, including internalized, anticipated, and enacted stigma. Each of these mechanisms is linked to a variety of adverse psychological, behavioral, and health outcomes. Intervening in HIV stigma mechanisms aims to disrupt the relationship between HIV stigma and its deleterious impact on PLWHA. We conclude by discussing HIV stigma in South Africa as a case example.