Addressing HIV-related Intersectional Stigma and Discrimination
By Joshua A. Gordon, M.D., Ph.D., and Maureen M. Goodenow, Ph.D., Associate Director for AIDS Research and Director, Office of AIDS Research, National Institutes of Health
Like the rest of society, the health research community is becoming more aware of interlocking systems of discrimination (e.g., structural racism and sexism) and the importance of considering intersectionality when addressing issues of equity and links with health outcomes. When interlocking systems of power and privilege confer stigma and discrimination on others, the combined effects can be incredibly harmful, particularly with respect to people’s health.
The considerable stigma and discrimination faced by people with HIV are among the most ubiquitous and consequential challenges to successful HIV prevention, treatment, and care. HIV-related stigma is created and expressed through irrational or negative attitudes, behaviors, and judgments toward people with, or at risk of, HIV. This includes discouraging stigmatized people from learning their HIV status, accessing treatment, or staying in care. Populations disproportionately affected by HIV frequently experience stigma and discrimination due to their race or ethnicity, gender identity, sexual orientation, substance use, and engagement in sex work, among other identities and social positions.
Addressing intersectional stigma in the context of HIV requires a strategic research response. Accordingly, the National Institutes of Health is broadening HIV stigma research to include the study of HIV-related intersectional stigma and discrimination to further develop, test, and implement interventions that improve HIV outcomes. Addressing HIV-related intersectional stigma and discrimination is explicitly identified as a priority in the NIH Strategic Plan for HIV and HIV-Related Research, developed by the NIH Office of AIDS Research (OAR).
The National Institute of Mental Health (NIMH) considers the issue of intersectionality in the context of HIV a crucial one to address. Critical work on this topic is carried out by the NIMH Division of AIDS Research. Its approach to intersectionality research emphasizes basic behavioral and social science research. This approach is guided by the priorities in the NIH Strategic Plan for HIV and HIV-Related Research and the NIH OAR priorities aimed at ending the HIV/AIDS pandemic and improving health outcomes for people with HIV. NIMH prioritizes theoretically driven bio-behavioral approaches to develop models and measurements to advance understanding of how HIV-related intersectional stigma and discrimination impacts HIV prevention and treatment outcomes. Similarly, NIMH prioritizes intervention research that mitigates HIV-related intersectional stigma and discrimination, improves outcomes of HIV disease, and examines mechanisms of behavioral and social change*.
To achieve our joint aims, NIMH and the NIH OAR work together, advancing research on HIV-related intersectional stigma and discrimination through research programs, initiatives, and other activities. One foundational effort was our jointly sponsored recent Funding Opportunity Announcement on Promoting Reductions in Intersectional StigMa (PRISM) to Improve the HIV Prevention Continuum. Grants funded in response to this announcement are studying interventions to enhance the accessibility and efficacy of healthcare in the context of intersectional stigma. NIMH and the NIH OAR co-organized a virtual workshop on this topic to discuss research advances and identify scientific gaps and opportunities in HIV intersectionality research; the report from this workshop is publicly available and serves to inform researchers regarding the next steps. Together, NIMH and the NIH OAR have also contributed to a Stigma and Discrimination Research Toolkit in collaboration with the National Institute on Drug Abuse, the Fogarty International Center, and the NIH Stigma Interest Group.
To further combat stigma and encourage sharing of perspectives and best practices, NIMH and the NIH OAR have co-sponsored a supplement to the American Journal of Public Health on Addressing Intersectional Stigma and Discrimination to Improve HIV-Related Outcomes, as well as an AIDS 2022 Satellite Symposium scheduled for July 31, 2022. We hope interested readers attending AIDS 2022 will join us for this symposium to learn more and help us find solutions to stigma and discrimination that will improve the lives of those affected by HIV.
*For more details on the NIH and NIMH approach to HIV stigma research, see https://pubmed.ncbi.nlm.nih.gov/33886010/