HIV, mpox, and stigma in West Africa - a case for integrated person-centred syndemic management.

Abstract

Across West Africa, HIV, mpox, stigma, and health-system barriers may interact in ways that compound clinical and social harms and challenge disease-specific models of care. This commentary proposes a practical, tripartite harm-reduction framework for integrated, person-centred syndemic management, designed not only to reduce morbidity associated with HIV and mpox but also to reduce harms arising from stigma, criminalization, inadvertent disclosure, and discriminatory health services. We propose: [1] integrated clinical pathways that provide HIV, mpox, and mental health services through co-location or discreet referral options while preserving voluntary access, confidentiality, and patient choice; [2] person-centred surveillance using ethically governed, de-identified data linkage to reduce fragmentation while protecting privacy and autonomy; and [3] funded, community-led interventions that address stigma, discrimination, criminalization, and exclusion from care through peer navigation, targeted communication, and legal and policy advocacy. We argue that this operational shift, supported by pragmatic implementation research, provides a testable approach to reducing clinical, social, and health-system harms associated with the syndemic. We encourage national health ministries, regional bodies, and global health partners to support the co-design, resourcing, and rigorous evaluation of pilot programmes in appropriate settings. Through integrated action that treats the whole person within their social context, this framework provides a testable approach to informing more equitable and resilient health-system responses in West Africa.Clinical trial number: Not applicable.