Despite advances in treatment, educational efforts, and mobilizations by people living with HIV, HIV stigma remains a community and public health problem. The shame and silence that continues to surround HIV often discourages disclosure, acts as a barrier to testing, and can impede medication adherence, care-seeking, and overall wellness among people living with HIV. Efforts to tackle stigma depend on how it has been defined.
Much scholarly literature and popular discourse takes a psychological approach to the issue, framing it as both a felt and enacted phenomenon—an individual condition, attribute, or mark that elicits negative attitudes and results in a person’s exclusion from mainstream society. Interventions in this arena typically target individual attitudes, values, and beliefs through workshop, counselling, and skills-building activities designed to cultivate empathy, empower individuals, and educate participants. Others have advocated more sociological approaches that treat stigma as a dynamic process shaped by power relations. Proponents of this perspective identify major social institutions such as schools, media, medicine, government, and law as sites in need of reform. Such approaches ask us to consider the ways in which stigma reproduces hierarchies and inequities among us, taking into account how social categories such as sexuality, gender, race/ethnicity, and nationality are not simply neutral descriptors of identity.