Journal of the International AIDS Society

Journal of the International AIDS Society


BioMed Central

Journal of the International AIDS Society


Open AcceReview Combating HIV stigma in health care settings: what works? Laura Nyblade*, Anne Stangl, Ellen Weiss and Kim Ashburn 

Address: International Center for Research on Women, Washington, DC, USA

Email: Laura Nyblade* – [email protected]; Anne Stangl – [email protected]; Ellen Weiss – [email protected]; Kim Ashburn – [email protected]

* Corresponding author

Abstract The purpose of this review paper is to provide information and guidance to those in the health care setting about why it is important to combat HIV-related stigma and how to successfully address its causes and consequences within health facilities. Research shows that stigma and discrimination in the health care setting and elsewhere contributes to keeping people, including health workers, from accessing HIV prevention, care and treatment services and adopting key preventive behaviours.

Studies from different parts of the world reveal that there are three main immediately actionable causes of HIV-related stigma in health facilities: lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour.

To combat stigma in health facilities, interventions must focus on the individual, environmental and policy levels. The paper argues that reducing stigma by working at all three levels is feasible and will likely result in long-lasting benefits for both health workers and HIV-positive patients. The existence of tested stigma-reduction tools and approaches has moved the field forward. What is needed now is the political will and resources to support and scale up stigma-reduction activities throughout health care settings globally.

Review A renewed global focus on HIV prevention, combined with a massive roll out of antiretroviral therapy, has focused worldwide attention on the ability of health facil- ities to deliver critical prevention, care and treatment serv- ices to a growing client population. HIV-related stigma and discrimination are now recognized as key barriers both to the delivery of quality services by health providers and to their utilization by community members and health providers themselves.

Unfortunately, the health sector is one of the main set- tings where HIV-positive individuals and those perceived

to be infected experience stigma and discrimination [1,2]. Studies show that HIV-related stigma in this context is per- nicious, and that its physical and mental health conse- quences to patients can be damaging [3-7]. Reducing HIV- related stigma in health settings should be a leading prior- ity for health care managers. Yet little attention has been paid to this issue, particularly in low-resource countries grappling with burgeoning HIV epidemics.

Three main challenges contribute to this lack of attention. First, there is limited recognition of the important link between HIV-related stigma and public health outcomes, such as patient quality of care, and health workforce