Why addressing HIV stigma should be our number one priority in the HIV response.

Abstract

If we are to achieve the UNAIDS 95-95-95 goals, and eventually eradicate HIV, we need to prioritise stigma reduction, and we need to be smart about how we do it. This position paper gives an overview of the ways in which HIV stigma impacts the cascade of care outcomes, provides guidance for effective stigma reductions interventions, and delineates priorities for understanding and addressing stigma in the HIV response. It makes clear that various forms of stigma deleteriously impact prevention and testing, linkage to care, initiation and adherence to antiretroviral treatment, and viral suppression, and it describes stigma reduction methods for public stigma, self-stigma, and structural stigma. It furthermore argues that stigma interventions should be systematically developed, theory- and evidence-based, tailored to context, and co-designed and co-implemented with recipient populations. Lastly, this paper argues for a better measurement of stigma, not by seeking consensus on construct definitions and corresponding measures but rather through the transparent reporting of definitions and their operationalisations.