Anthony K J Smith

Discrimination and stigma limit the health, well-being, and human rights of communities, and can undermine engagement with health services and HIV testing, prevention and treatment HIV. This session focused on understanding the internalized and interpersonal factors shaping stigma, along with one psychological intervention aimed at reducing internalized stigma.

Dr Ye Zhang (UNSW, Australia) explored how ‘standardized patients’ can be used to understand the subtle effects of sexuality and HIV-based stigma in health consultations in China. They found health providers were less likely to offer syphilis testing to actors posing as men who have sex with men living with HIV, compared to those posing as HIV-negative heterosexual people. Dr Julie Pulerwitz (Population Council, United States) presented an evaluation of a randomized group-based cognitive behavioral therapy (CBT) internalized stigma intervention for MSM and transgender women at risk of or living with HIV in Nigeria. The study found that the intervention was acceptable, produced some mental health benefits, but that the randomized design was confounded. Dr Salih Atakan Nemli (Izmir Katip Celebi University, Türkiye) presented a cross-sectional online survey of medical students in Türkiye, concluding that political conservatism and negative stereotyping were associated with attitudes of social distancing towards people living with HIV. Dr Ines Aristegui (Fundacion Huesped, Argentina) explored the relationships between gender identity stigma and sexual risk behaviour in transgender women in a prospective cohort study in Argentina. The study concluded that depressive symptoms played a mediating role in the association between gender identity stigma and condomless anal sex.

All studies advocated for attending to the compounding factors that shape stigma. However, there was critique from the audience that much more work is needed to focus on stigma interventions. Further, it was less clear how health providers can be better sensitised and trained to reduce stigma. Dr Pulerwitz and Dr Aristegui clarified that in their study settings, concentrated work was undertaken to train health staff and set up a supportive environment. The moderator (Professor Gary Dowsett) reflected that the concept of stigma holds together many complicated social processes and dynamics, making it difficult to measure and intervene.