The dominant view in the public health community is that the stigma of being HIV positive fuels the HIV epidemic, and yet there is a lack of evidence to support this view, say two researchers in a provocative essay in PLoS Medicine.
In a 2002 report, UNAIDS declared that the stigma associated with HIV was one of the "greatest barriers" to preventing new HIV infections and alleviating the impact of the disease. The standard argument for the link between HIV stigma and the global HIV epidemic, say Daniel Reidpath (Brunel University, UK) and Kit Yee Chan (Deakin University, Australia) is that stigma undermines HIV prevention efforts by making a person afraid to engage in safe behavior or seek testing for fear that these acts would themselves raise suspicion in the minds of others about the person's HIV status.
Reidpath and Chan say that there is no good evidence to support this argument. "To establish a causal link between HIV stigma and epidemic progression," they say, "requires longitudinal data on rates of infection and levels of HIV stigma. Weaker, but nonetheless potentially persuasive, evidence could also be found in an observed correlation between levels of HIV-related stigma and rates of HIV infection across contexts--such as between countries. Currently, no such evidence is available."
An alternative hypothesis, they say, is that stigma may in fact help to slow the epidemic. "It is plausible," they say, "that a social control mechanism, such as stigma, could reduce opportunities for contact between high- and low-risk groups."
"In writing this essay," say the authors, "our aim was neither to diminish the suffering of people living with AIDS in the eyes of the reader nor to advocate for the use of HIV stigma as a mechanism to control the spread of the epidemic. Our objective was to draw attention to the lack of evidence supporting the current dominant view on the relationship between stigma and the global spread of HIV."
Citation: Reidpath D, Chan KY (2006) HIV, sigma, and rates of infection: A rumor without evidence. PLoS Med 3(10): e435.
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- Caption: The Argument for the Link Between the Stigma of HIV and the Global HIV Epidemic
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