Background on Stigma

HIV and intersectional stigma reduction in the HIV healthcare setting is a primary focus of the Quality of Care (QOC) Program. We define stigma as a dynamic social process that involves the labeling, stereotyping, separation, status loss, and resulting discrimination that occurs within a context of a power imbalance at the structural, interpersonal, and individual levels. Neither HIV nor stigma are one-dimensional issues; It is no longer sufficient to focus on one stigma at a time in the context of ending an HIV epidemic that is driven by HIV stigma, sexism, racism, transphobia, homophobia, classicism, ableism, and stigma towards mental health and substance use. The communities most inequitably impacted by HIV and among whom evidence-based interventions often don’t reach are facing multiple, interlocking structures that oppress them in ways that are common across and unique within groups at these intersections.

HIV stigma and other stigmas, that intersect with and can increase the deleterious effects of HIV stigma, have been identified as significant barriers to achieving goals of the National HIV AIDS Strategy, and to quality of care outcomes for people living with HIV. The QOC Program focuses on reducing stigma at the following three levels of manifestation:

• The individual level (internalized and anticipated stigma) - the way a PLWH might view themselves and the expectations they have for how they will be treated within the facility
• The interpersonal level (enacted stigma) - the way HIV clinic staff interact with PLWH through norms and expectations for how community members are treated
• The structural level - the way organizational policies, practices, care environment and infrastructure impact stigma