People living with HIV/AIDS (PLHIV) face prejudice, fear, rejection, and stigmatization. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world. Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.
HIV/AIDS discrimination takes many forms such as blood donation restrictions on at-risk populations, compulsory HIV testing without prior consent, violations of confidentiality within healthcare settings, and targeted violence against PLHIV. In addition, HIV discrimination is a global issue that affects individuals despite respective nation laws prohibiting HIV/AIDS discrimination. HIV/AIDS discrimination lowers the chances of PLHIV to seek help, and can affect advancement of treatments.
HIV-related stigma HIV stigma is a negative opinion or belief towards people with HIV. HIV discrimination is a negative action or behavior towards people with HIV that stem from HIV stigma. HIV/AIDS stigma is divided into the following three categories: Instrumental AIDS stigma: A reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness. Symbolic AIDS stigma: The use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease. Courtesy AIDS stigma: Stigmatization of people connected to the issue of HIV/AIDS or HIV-positive people.
PLHIV may also experience internalized stigma. Internalized stigma is when a person applies negative ideas or stereotypes about HIV towards themselves. This can lead to feelings of shame or isolation. Internalized stigma can increase the fear that an HIV diagnosis will be disclosed, and subsequently, increase fear of discrimination or lack of acceptance due to the HIV positive status. UNAIDS, in a study across 25 countries, reports 85% of people experience internalized stigma. HIV-related stigma and discrimination can negatively impact the mental health of people living with HIV.
Stigma towards people living with HIV is widespread. In 35 percent of countries with available data, UNAIDS reports 50 percent of people admitted to having stigma towards people living with HIV. The People Living with HIV Stigma Index (PLHIV Stigma Index) exists as a tool to collect evidence on the prevalence and impact of stigma and discrimination towards people living with HIV. The PLHIV Stigma Index was developed by GNP+, ICW, UNAIDS and IPPF in 2008, and is utilized in over 100 countries. Individual country reports of the PLHIV Stigma Index are available from 2016 and beyond.
Domestic stigmatization Domestic stigmatization refers to HIV-related stigma that takes place within the home or familial environment. This form of stigma is distinct from institutional or healthcare stigma because it occurs in private, interpersonal contexts, often involving family members, romantic partners, neighbors, or live-in caregivers. Examples include being isolated within the home, denied access to shared household items, forcibly evicted by relatives, or subjected to verbal or physical abuse due to one’s HIV status.
A 2020 review of 37 studies across multiple countries identified 51 distinct acts of domestic stigmatization reported by PLHIV, with women disproportionately affected. These experiences were linked to microaggressions, emotional distress, and withdrawal from social or medical support systems. The study emphasizes the need for stigma-reducing interventions that target family dynamics and domestic spaces, where support is often assumed but not always present.
People living with HIV face discrimination in many sectors, including healthcare, education, employment, and law enforcement. Discrimination takes the form of denial of services, lack of accessible services for key populations, and insufficient funding and scale for services. In conjunction to internalized stigma, HIV/AIDS stigma and discrimination make it more difficult for PLHIV to feel comfortable in obtaining the medical services they need.
Misconceptions about HIV in the US
Today, there continues to be significant misconceptions about HIV within the US. Furthermore, misconceptions about the transmission of HIV promotes fear amongst many members of society, and this often translates into biased and discriminatory actions against PLHIV.
A 2009 study conducted by the Kaiser Family Foundation found that many Americans still lack basic knowledge about HIV. According to the survey, a third of Americans believe that HIV could be transmitted through sharing a drink or touching a toilet used by an HIV-positive individual. Furthermore, the study reported that 42 percent of Americans would be uncomfortable with having an HIV-positive roommate, 23 percent would be uncomfortable with an HIV-positive coworker, 50 percent would be uncomfortable with an HIV-positive person preparing their food, and 35 percent would be uncomfortable with their child having an HIV-positive teacher. Many of the respondents who were able to correctly answer questions about HIV transmission still reported similar biased views against HIV-positive individuals; in fact, 85 percent of these respondents reported that they would feel uncomfortable working with an HIV-positive coworker.
Some of the misconceptions about HIV within the US could result from a failure to prevent misinformation from spreading and a lack of accurate information being published. "The lack of adequate resources devoted to AIDS in the early days of the epidemic curtailed surveillance efforts and epidemiological studies at the C.D.C. and markedly hampered the biomedical research community's ability to respond."
Misconceptions about transmission of HIV The only way that HIV can be transmitted from one individual to the next is by sharing of certain bodily fluids such as semen, blood, and vaginal discharge which the virus uses as a medium to enter the bloodstream of the recipient; HIV is not transmissible via fluids such as saliva, sweat, tears, or urine as it is not in high enough concentrations to spread in these matters. In order for HIV to enter another person, either the semen, blood, or vaginal discharge must find an entry point by way of injection, unprotected sex, or during pregnancy as the mother can pass it along; one would only contract the virus when coming in direct contact with these fluids, for example, with an open cut on the skin that exposes blood.
PLHIV do not always pass on the virus to someone else when engaging in sexual activities or sharing bodily fluids; PLHIV can have no transmission risk by taking medication which lowers the amount of HIV virus present in the bloodstream, rendering the individual as having an undetectable viral load. Pre-exposure prophylaxis (PrEP), on the other hand, is a drug that is used regularly as a preventative measure against HIV for those who are at a higher risk of contracting the virus but does not cure someone who has HIV.
People can not contract AIDS, rather they are infected with HIV which progresses into AIDS over time when left unchecked; if someone has HIV, it does not guarantee that they will develop AIDS, which is even more prevented when taking medication such as antiretroviral therapy (ART) to lower viral load.
Misconceptions about at-risk populations Tim McCaskell, a Canadian writer and HIV/AIDS advocate, explains that AIDS was seen as a political problem against marginalized people. AIDS Action Now explored how medical professionals were mistreating PLHIV patients. Furthermore, he also found out that there was a lack of funds for research or education. Doctors were not fulfilling their roles as fiduciaries for marginalized people while the public believed that the doctor-patient relationship meant remaining as neutral as possible.
Many people incorrectly believe that HIV is exclusive to gay men who have sex, but, although the risks are higher for gay and bisexual males, anyone is susceptible to contracting the virus regardless of their sexual orientation, race, age, and so forth. Some forms of violence such as childhood trauma, rape, and sexual assault can lead people to engage in unsafe sexual practices that could increase their chances of contracting HIV. For example, in some cases, young girls and women who experience these traumatic events become sex workers or engage in prostitution which further increases their risk of contracting HIV.
These discriminatory views of PLHIV also persist within the medical field. A 2006 study of health professionals in Los Angeles County found that 56 percent of nursing facilities, 47 percent of obstetricians, and 26 percent of plastic surgeons had unlawfully refused to treat an HIV-positive patient, citing concerns of HIV transmission. Overall, this societal stigma and discrimination has exacerbated distrust towards healthcare workers within the HIV-positive population. The health care community therefore has an ethical duty to dispel stereotypes and misconceptions about HIV.
Discriminatory practices in healthcare settings Discriminatory practices within the medical field have been found to greatly impact the health outcomes of PLHIV. In both low-income and high-income nations, there have been several reported cases of medical providers administering low-quality care or denying care altogether to patients with HIV. In a 2013 study conducted in Thailand, 40.9 percent of health workers reported worrying about touching the clothing and personal belongings of patients with HIV, despite possessing the knowledge that HIV does not spread through such items. In a 2008 study of 90 countries, one in four PLHIV reported experiencing some form of discrimination in healthcare settings. Furthermore, one in five individuals with HIV reported having been denied medical care. Even more concerning is the impact HIV-related discrimination has had on HIV-positive women. According to the 2008 study, one in three women living with HIV have reported instances of discrimination related to their sexual and reproductive health within a healthcare setting. In another study of 23 countries, in every country women have reported reproductive coercion. In addition, intersectionality affects the stigma and discrimination against these women. Furthermore, it has been reported that many health care workers in Europe and Central Asia lack knowledge about how HIV is transmitted, leading to them avoiding physical contact with PLHIV and feeling reserved about providing care to populations with a high HIV-prevalence.