Addressing the sixteenth International AIDS Conference in 2006, the then Executive Director of UNAids, Peter Piotremarked: “Since the beginning of the epidemic, stigma, discrimination and gender inequality have been identified as major causes of personal suffering, and major barriers to effective HIV responses.”
Now, within the fourth decade of the HIV crisis, this statement is essentially true. Despite leaps and bounds in HIV treatment and prevention, stigma and discrimination proceed to harm the lives of individuals living with HIV, and hamper efforts to stop the epidemic globally.
HIV Today: A Changing Landscape
HIV is now a highly treatable condition with excellent outcomes. People living with HIV who're on treatment can expect to live healthy lives. A normal life.
Importantly, the drugs are so effective that they reduce the quantity of virus within the body to undetectable levels. This means that folks living with HIV cannot pass the virus to others – a condition called “U=U”, or undetectable equals untransferable.. The evidence supporting this is robust and widespread. More than 20 years.
The most comprehensive proof for U=U follows from this. partner And Partner II The study, which aimed to find out the chance of transmission between HIV-positive and HIV-negative partners when the positive partner is virally suppressed.
These large observational studies tracked a combined 2,020 couples—heterosexual and heterosexual—over several years of follow-up. Between the 2 studies, participants reported 134,000 acts of unprotected sex, but transmission of HIV between couples was not recorded.
The evidence was incontrovertible and the study authors concluded that when an individual is virally suppressed, their risk of transmission is zero. This is incredibly reassuring for people living with HIV, who can feel confident that they can't pass the virus on to their partners.
This can also be excellent news for public health. The World Health Organization is endorsing the U=U message. and reaffirming the importance of treatment as a crucial prevention tool in the continuing HIV epidemic.
Stigma: A Persistent Barrier
Despite these extraordinary medical advances, HIV-related stigma stays a persistent barrier that negatively affects health and well-being. People living with HIV.
The first European-wide community survey of People living with HIVPublished by the European Center for Disease Control (ECDC) in 2023, it was reported that of three,272 respondents, one in three didn't tell a member of the family their diagnosis for fear of rejection.
In the identical study, one-third of respondents also reported experiencing stigma in health care settings, with nearly one-quarter reporting being denied health care because of this of their HIV status. or delayed.
Oh A later ECDC study A study of HIV-related stigma amongst 18,000 European healthcare staff published in July 2024 found that just about two-thirds were apprehensive about drawing blood from HIV patients and 1 / 4 used double gloves with such patients. Reported to do.
That HIV-related stigma is so common and customary in health care settings is especially troubling. Create such experiences. Mistrust between people living with HIV and their health care providers This can lead people living with HIV to avoid participating in health care services, which has clear knock-on effects for health.
Additionally, there's evidence that HIV-related stigma is experienced in health care settings. Associated with poor adherence to antiretroviral medications and treatment failure.
This is bad for individual health, but it may possibly occur. Adverse effects on public healthprovided that treatment is a crucial preventive tool.
Reducing HIV stigma in health care settings
A lot of aspects, including fear of HIV, negative attitudes, lack of policies and lack of coaching of health care staff, can increase HIV-related stigma in health care settings.
In Ireland, where my research relies, As part of a wider project In 2022 we conducted a survey of 295 healthcare staff to measure stigma in Irish healthcare settings. our ResultsPublished earlier this 12 months, it provides tentative recent evidence for the potential of the U=U message to scale back HIV-related stigma.
Similar to other studies, we found that fear of HIV was a serious driver of stigma in healthcare settings in Ireland. More than half of our survey respondents said they'd be concerned about drawing blood from a patient living with HIV, and greater than 1 / 4 reported using special measures that they'd use for other patients. Do not use together, comparable to double gloves.
What was unique about our study was that, for the primary time, we measured knowledge of U=U amongst healthcare staff. We found that, while other aspects were relevant, knowledge of U=U was probably the most powerful protective factor against HIV fear and stigmatizing behavior.
In other words, health care staff who're confident within the U=U message are less prone to stigmatize people living with HIV.
Stigma is a posh social phenomenon, and no single intervention against it should be fully effective. However, our research suggests that increasing awareness and acceptance of U=U can be an efficient, cost-effective and scalable process that will help us move towards a stigma-free future. Can take close.