Question

Why isnt more being done to end the stigma surrounding HIV? It seems so much money is continually being spent on new hiv medications and finding a cure , when we already have all the tools we need to end the epidemic if we can get rid of the stigma so everyone living with hiv will get and stay in treatment and end new transmissions.
Please correct me if Im wrong, but if an equal amount of money would be spent to end the stigma, wouldnt we see an end to the hiv epidemic? I am living with HIV for 30 years and ive been here for so many advances but we are going backwards in regards to stigma.

We are so close to a functional cure if we get everyone diagnosed and in treatment! The only reason we are not doing it yet , in my experience , is due to stigma. Please help end this epidemic!

Answer

Hello and thanks for posting your thought provoking and important question.

I'll agree with you that while much has been done to address stigma, discrimination and criminalization of people living with- or affected by HIV, that there's still much more work to be done if all are to realize the full life-saving potential of current diagnostic and therapeutics aimed at prevention and treatment of the virus.

Part of the issue is that investment in science can yield effective medicines and treatments, but the treatment of stigma lies in changes in law and evolution of personal, institutional and social cultures. Where I work, at the International Association of Providers of AIDS Care (IAPAC), we appreciate the critical role that stigma, discrimination and criminalization of people play in preventing access to testing, care and medications. To this end, the very first four of 36 evidence-based recommendations to optimize the HIV care continuum are directed at these key issues. They are: 1. Laws that criminalize the conduct of or exert punitive legal measures against men who have sex with men (MSM), transgender individuals, substance users, and sex workers are not recommended and should be repealed where they have been enacted. 2. Laws that criminalize the conduct of people living with HIV (PLHIV) based on perceived exposure to HIV, and without any evidence of intent to do harm, are not recommended and should be repealed where they have been enacted. 3. HIV-related restrictions on entry, stay, and residence in any country for PLHIV are not recommended and should be repealed. 4. Strategies to monitor for and eliminate stigma and discrimination based on race, ethnicity, gender, age, sexual orientation, and/or behavior in all settings, but particularly in healthcare settings, using standardized measures and evidence-based approaches, are recommended.

The IAPAC care continuum guidelines are summarized in a
series of Fact Sheets at AIDSInfoNet.org.

Stigma and discrimination exist in multiple places- self, community, healthcare facilities and in the general society. Changing all of these will take a concerted and prolonged effort. Yet, I believe that a good starting place to implement these strategies is within healthcare facilities and among ourselves individually.

Ending the AIDS epidemic (if not new HIV infections) will require more than just a test or a pill (though does require both of these and more), but a sea change: an appreciation that people need not be discriminated against, nor die because of HIV infection. I'm not sure this issue will be solved by simply looking at monies invested, or asking for parity addresses the core challenges, (though trends in investments is a telling indicator), but rather meaningful leadership on having a more just society- from government, from medical providers and associations, faith-based organizations and from civil society; indeed from all quarters is necessary. In many places (including the United States), belief in a more just world is under threat, and it's your concern for retrogression is understandable. Yet, I'm en eternal (if pragmatic) optimist. 2018 is not 1988 when it comes to our understanding of HIV, AIDS or stigma and discrimination. Death from AIDS, in spite of tremendous gaps in legal and health equity has decreased (and in some places has become uncommon). The question is whether, as a global community, we have the belief and fortitude to make AIDS a rare thing for all.

Be well, BY