Stigma and discrimination

Definition

Stigma refers to neg­a­tive stereo­types or assump­tions about peo­ple. When stigma trans­lates into actions that exclude, dis­en­fran­chise, or harm peo­ple is called dis­crim­i­na­tion. For exam­ple, the stigma that peo­ple who inject drugs are unre­li­able could trans­late to the dis­crim­i­na­tory action of unjus­ti­fy­ing ter­mi­nat­ing their employ­ment. Many types of stigma are rooted in and prop­a­gated by cul­tural and social norms, like rigid gen­der norms and stereo­types. Dis­crim­i­na­tion can be cod­i­fied into laws and poli­cies, like the crim­i­nal­i­sa­tion of sex work and the LGBTQIA+ com­mu­nity. Together, stigma and dis­crim­i­na­tion may lead to vio­lence, humil­i­a­tion, trauma, denial of life-sav­ing care, social ostraci­sa­tion, and incar­cer­a­tion, among other con­se­quences.

Key pop­u­la­tions are espe­cially affected by stigma and dis­crim­i­na­tion. The expec­ta­tion of dis­crim­i­na­tion can be a deter­rent for peo­ple seek­ing HIV infor­ma­tion or test­ing, engag­ing with sup­port groups or sys­tems, and shar­ing sen­si­tive but cru­cial infor­ma­tion with health­care providers. Even those able to access and afford sup­port may face stigma and dis­crim­i­na­tion, since key pop­u­la­tions are often refused care or so poorly treated that they never return.

Com­mu­nity-based inter­ven­tions are also ham­pered by these obsta­cles. In crim­i­nalised set­tings, for exam­ple, it can be dif­fi­cult to find trust­wor­thy, con­fi­den­tial resources or engage peo­ple who expect their human rights will be vio­lated. But key pop­u­la­tion lead­er­ship is cru­cial to rights-based responses to stigma and dis­crim­i­na­tion–not only do they vary dras­ti­cally by com­mu­nity, they also man­i­fest in lived expe­ri­ences and require care­fully tai­lored responses.

Precedents

2022 Resolution on Violence Against Women Migrant Workers

• “Also calls upon Gov­ern­ments to rec­og­nize the right of women migrant work­ers and their accom­pa­ny­ing chil­dren, regard­less of their migra­tory sta­tus, to have access with­out dis­crim­i­na­tion to emer­gency health care, includ­ing in times of human­i­tar­ian crises, nat­ural dis­as­ters, pan­demics and other emer­gency sit­u­a­tions, and in this regard to ensure that women migrant work­ers are not dis­crim­i­nated against on the grounds of preg­nancy and child­birth and, in accor­dance with national leg­is­la­tion, to address the vul­ner­a­bil­i­ties to HIV expe­ri­enced by migrant pop­u­la­tions and sup­port their access to HIV pre­ven­tion, treat­ment, care and sup­port.” (para­graph 22)

• “Encour­ages States to con­sider ensur­ing that all women migrant work­ers, regard­less of their migra­tion sta­tus, can exer­cise their human rights through safe access to basic ser­vices, notwith­stand­ing that nation­als and reg­u­lar migrants may be enti­tled to more com­pre­hen­sive ser­vice pro­vi­sion, while ensur­ing that any dif­fer­en­tial treat­ment must be based on law, be pro­por­tion­ate and pur­sue a legit­i­mate aim, in accor­dance with inter­na­tional human rights law.” (para­graph 29)

2021 Global AIDS Strategy 2021-2026

• “Less than 10% of peo­ple liv­ing with HIV and key pop­u­la­tions expe­ri­ence stigma and dis­crim­i­na­tion;
  (i) Less than 10% of peo­ple liv­ing with HIV report inter­nal­ized stigma by 2025;
  (ii) Less than 10% of peo­ple liv­ing with HIV report expe­ri­enc­ing stigma and dis­crim­i­na­tion in health care and com­mu­nity set­tings by 2025;
  Less than 10% of key pop­u­la­tions (i.e., gay men and other men who have sex with men, sex work­ers, trans­gen­der peo­ple and peo­ple who inject drugs) report expe­ri­enc­ing stigma and dis­crim­i­na­tion by 2025;
  (iii) Less than 10% of the gen­eral pop­u­la­tion reports dis­crim­i­na­tory atti­tudes towards peo­ple liv­ing with HIV by 2025;
  (iv) Less than 10% of health work­ers report neg­a­tive atti­tudes towards peo­ple liv­ing with HIV by 2025;
  (v) Less than 10% of health work­ers report neg­a­tive atti­tudes towards key pop­u­la­tions by 2025;
  (vi); Less than 10% of law enforce­ment offi­cers report neg­a­tive atti­tudes towards key pop­u­la­tions by 2025.” (annex 1, 2025 tar­gets)

• “80% ser­vices for women, includ­ing pre­ven­tion ser­vices for women at increased risk to acquire HIV, as well as pro­grammes and ser­vices for access to HIV test­ing, link­age to treat­ment (ART), adher­ence and reten­tion sup­port, reduc­tion/elim­i­na­tion of vio­lence against women, reduc­tion/elim­i­na­tion of HIV related stigma and dis­crim­i­na­tion among women, legal lit­er­acy and legal ser­vices spe­cific for women- related issues, to be deliv­ered by com­mu­nity-led orga­ni­za­tions that are women-led” (annex 2, 2025 tar­gets)

• “ 60% of the pro­grammes sup­port­ing the achieve­ment of soci­etal enablers, includ­ing pro­grammes to reduce/elim­i­nate HIV-related stigma and dis­crim­i­na­tion, advo­cacy to pro­mote enabling legal envi­ron­ments, pro­grammes for legal lit­er­acy and link­ages to legal sup­port, and reduc­tion/elim­i­na­tion of gen­der-based vio­lence, to be deliv­ered by com­mu­nity-led orga­ni­za­tions.” (annex 2, 2025 tar­gets)

• “Rec­og­niz­ing the equal worth and dig­nity of every per­son is not only an eth­i­cal imper­a­tive and an oblig­a­tion aris­ing from inter­na­tional human rights instru­ments, it is cen­tral for end­ing AIDS as a pub­lic health threat. SDG 3 can­not be achieved if stigma, dis­crim­i­na­tion, crim­i­nal­iza­tion of key pop­u­la­tions, vio­lence, social exclu­sion and other human rights vio­la­tions in the con­text of HIV are allowed to con­tinue and if HIV-related inequal­i­ties per­sist. The evi­dence con­sis­tently shows that the crim­i­nal­iza­tion of peo­ple liv­ing with HIV and key pop­u­la­tions reduces ser­vice uptake and increases HIV inci­dence. Gen­der inequal­i­ties also increase the HIV vul­ner­a­bil­ity of women and girls, with women who expe­ri­ence inti­mate part­ner vio­lence in high-preva­lence set­tings more than 50% more likely to be liv­ing with HIV.” (para­graph 129)

• “Reach­ing the soci­etal enabler tar­gets in this Strat­egy is cru­cial. Mod­el­ling indi­cates that fail­ure to reach the tar­gets for stigma and dis­crim­i­na­tion, crim­i­nal­iza­tion and gen­der equal­ity will pre­vent the world from achiev­ing the other ambi­tious tar­gets in the Strat­egy and will lead to an addi­tional 2.5 mil­lion new HIV infec­tions and 1.7 mil­lion AIDS-related deaths between 2020 and 2030.” (para­graph 85)

2021 Political declaration on HIV and AIDS

• “Express deep con­cern about stigma, dis­crim­i­na­tion, vio­lence and restric­tive and dis­crim­i­na­tory laws and prac­tices that tar­get peo­ple liv­ing with, at risk of and affected by HIV–includ­ing for non-dis­clo­sure, expo­sure and trans­mis­sion of HIV–and laws that restrict the move­ment or access to ser­vices for peo­ple liv­ing with, at risk of and affected by HIV, includ­ing key pop­u­la­tions, young peo­ple, women and girls in diverse sit­u­a­tions and con­di­tions, and in this regard, deplore acts of vio­lence and dis­crim­i­na­tion in all regions of the world.” (para­graph 28)

2021 CSW Report on women and HIV/AIDS

• “More than a quar­ter of peo­ple aged 15 to 49 years in 52 out of 58 coun­tries with pop­u­la­tion-based sur­vey data hold dis­crim­i­na­tory atti­tudes towards peo­ple liv­ing with HIV, and, in 36 coun­tries, more than half held such views. Dis­crim­i­na­tion in health-care set­tings can deter access to test­ing and treat­ment.” (para­graph 39)

2020 Resolution on violence against women migrant workers

• “Also calls upon Gov­ern­ments to rec­og­nize the right of women migrant work­ers and their accom­pa­ny­ing chil­dren, regard­less of their migra­tory sta­tus, to have access with­out dis­crim­i­na­tion to emer­gency health care, includ­ing in times of human­i­tar­ian crises, nat­ural dis­as­ters and other emer­gency sit­u­a­tions, and in this regard to ensure that women migrant work­ers are not dis­crim­i­nated against on the grounds of preg­nancy and child­birth and, in accor­dance with national leg­is­la­tion, to address the vul­ner­a­bil­i­ties to HIV expe­ri­enced by migrant pop­u­la­tions and sup­port their access to HIV pre­ven­tion, treat­ment, care and sup­port.” (para­graph 22)

2019 Political declaration of the HLM on UHC

• “Rec­og­nize the fun­da­men­tal impor­tance of equity, social jus­tice and social pro­tec­tion mech­a­nisms as well as the elim­i­na­tion of the root causes of dis­crim­i­na­tion and stigma in health-care set­tings to ensure uni­ver­sal and equi­table access to qual­ity health ser­vices with­out finan­cial hard­ship for all peo­ple, par­tic­u­larly for those who are vul­ner­a­ble or in vul­ner­a­ble sit­u­a­tions.” (para­graph 14)

2018 HRC Resolution on human rights in the context of HIV and AIDS

• “Urges States to address the mul­ti­ple and inter­sect­ing forms of dis­crim­i­na­tion and the spe­cific health-care needs expe­ri­enced by migrant and mobile pop­u­la­tions, and by refugees and cri­sis-affected pop­u­la­tions, in the con­text of HIV and to elim­i­nate stigma, dis­crim­i­na­tion and vio­lence, as well as to review poli­cies related to restric­tions on entry on the basis of HIV sta­tus with a view to elim­i­nat­ing such restric­tions and the return of peo­ple on the basis of their HIV sta­tus, and to sup­port their access to HIV pre­ven­tion, diag­no­sis, treat­ment, care and sup­port.” (para­graph 19)

• “Urges States to ensure full and unim­peded access for all per­sons liv­ing with, pre­sumed to be liv­ing with, at risk of or affected by HIV, includ­ing key pop­u­la­tions, to HIV pre­ven­tion, diag­no­sis, treat­ment, care and sup­port, in a pub­lic health envi­ron­ment free from dis­crim­i­na­tion, harass­ment or per­se­cu­tion against those seek­ing HIV-related ser­vices, while respect­ing and pro­tect­ing their right to pri­vacy, con­fi­den­tial­ity and free and informed con­sent.” (para­graph 4)

2017 Resolution on international cooperation to address and counter the world drug problem

• “Urges Mem­ber States to ensure non-dis­crim­i­na­tory access to health, care and social ser­vices in pre­ven­tion, pri­mary care and treat­ment pro­grammes, includ­ing those offered to per­sons in prison or pre­trial deten­tion, which are to be on a level equal to those avail­able in the com­mu­nity, and to ensure that women, includ­ing detained women, have access to ade­quate health ser­vices and coun­sell­ing, includ­ing those par­tic­u­larly needed dur­ing preg­nancy.” (para­graph 28)

2016 Outcome Document of the Session on the World Drug Problem

• “Ensure non-dis­crim­i­na­tory access to health, care and social ser­vices in pre­ven­tion, pri­mary care and treat­ment pro­grammes, includ­ing those offered to per­sons in prison or pre­trial deten­tion, which are to be on a level equal to those avail­able in the com­mu­nity, and ensure that women, includ­ing detained women, have access to ade­quate health ser­vices and coun­sell­ing, includ­ing those par­tic­u­larly needed dur­ing preg­nancy.” (para­graph 4(b))

2016 Resolution on Women, the Girl Child and HIV and AIDS

• “Calls upon Mem­ber States to address gen­der-based HIV-related stigma and dis­crim­i­na­tion against and among women and girls, so as to ensure the dig­nity, rights and pri­vacy of women and girls liv­ing with and affected by HIV and AIDS, includ­ing in edu­ca­tion, train­ing and infor­mal edu­ca­tion and the work­place.” (para­graph 8)

2012 Resolution on women in development

• “Encour­ages Mem­ber States to adopt and imple­ment leg­is­la­tion and poli­cies designed to pro­mote the rec­on­cil­i­a­tion of work and fam­ily respon­si­bil­i­ties, includ­ing through increased flex­i­bil­ity in work­ing arrange­ments, such as part-time work, and the facil­i­ta­tion of breast­feed­ing for work­ing moth­ers, to pro­vide care facil­i­ties for chil­dren and other depen­dants, and to ensure that both women and men have access to mater­nity or pater­nity, parental and other forms of leave and are not dis­crim­i­nated against when avail­ing them­selves of such ben­e­fits.” (para­graph 15)

• “Urges all Mem­ber States to take all appro­pri­ate mea­sures to elim­i­nate dis­crim­i­na­tion against women with regard to their access to all types of finan­cial ser­vices and prod­ucts, includ­ing bank loans, bank accounts, mort­gages and other forms of finan­cial credit, regard­less of their eco­nomic and social sta­tus, to sup­port women’s access to legal assis­tance and to encour­age the finan­cial sec­tor to main­stream gen­der per­spec­tives in their poli­cies and pro­grammes.” (para­graph 23)

• “Urges all Gov­ern­ments to elim­i­nate dis­crim­i­na­tion against women in the field of edu­ca­tion and ensure their equal access to all lev­els of edu­ca­tion.” (para­graph 26)

2011 Political Declaration on HIV and AIDS

• “Reaf­firm that the full real­iza­tion of all human rights and fun­da­men­tal free­doms for all is an essen­tial ele­ment in the global response to the HIV epi­demic, includ­ing in the areas of pre­ven­tion, treat­ment, care and sup­port, rec­og­nize that address­ing stigma and dis­crim­i­na­tion against peo­ple liv­ing with, pre­sumed to be liv­ing with or affected by HIV, includ­ing their fam­i­lies, is also a crit­i­cal ele­ment in com­bat­ing the global HIV epi­demic, and rec­og­nize also the need, as appro­pri­ate, to strengthen national poli­cies and leg­is­la­tion to address such stigma and dis­crim­i­na­tion.” (para­graph 39)

• “Rec­og­nize that close coop­er­a­tion with peo­ple liv­ing with HIV and pop­u­la­tions at higher risk of HIV infec­tion will facil­i­tate the achieve­ment of a more effec­tive HIV and AIDS response, and empha­size that peo­ple liv­ing with and affected by HIV, includ­ing their fam­i­lies, should enjoy equal par­tic­i­pa­tion in social, eco­nomic and cul­tural activ­i­ties, with­out prej­u­dice and dis­crim­i­na­tion, and that they should have equal access to health care and com­mu­nity sup­port as all mem­bers of the com­mu­nity.” (para­graph 40)

• “Com­mit to pro­mot­ing laws and poli­cies that ensure the full real­iza­tion of all human rights and fun­da­men­tal free­doms for young peo­ple, par­tic­u­larly those liv­ing with HIV and those at higher risk of HIV infec­tion, so as to elim­i­nate the stigma and dis­crim­i­na­tion they face.” (para­graph 83)

2010 HRC Resolution on the elimination of discrimination against women

• “Reaf­firms the oblig­a­tion of States to take all appro­pri­ate mea­sures to elim­i­nate dis­crim­i­na­tion against women by any per­son, orga­ni­za­tion or enter­prise.” (para­graph 1)

• “Calls upon States to pay par­tic­u­lar atten­tion to dis­crim­i­na­tion against women in sit­u­a­tions of vul­ner­a­bil­ity, such as women liv­ing in poverty, migrant women, women with dis­abil­i­ties and women belong­ing to minori­ties.” (para­graph 17)

2009 ECOSOC Resolution on UNAIDS

• “Acknowl­edges the insid­i­ous and per­sis­tent dri­vers of the epi­demic, in par­tic­u­lar stigma, dis­crim­i­na­tion, gen­der inequal­ity, socio-eco­nomic inequal­ity and lack of respect for human rights, also acknowl­edges that in some cases food inse­cu­rity and dis­place­ments, for exam­ple, can lead to increased vul­ner­a­bil­ity, and encour­ages inten­si­fied analy­sis and advo­cacy by the Joint Pro­gramme to ensure that under­ly­ing obsta­cles to uni­ver­sal access are under­stood and appro­pri­ately addressed at all lev­els and in all set­tings, includ­ing through ser­vices to under­served and vul­ner­a­ble pop­u­la­tions.” (para­graph 4)

Expert precedents

2022 OHCHR Annual Report on Human Rights and HIV/AIDS

• “Rec­om­mend that vio­lence, abuse and dis­crim­i­na­tion against peo­ple from key pop­u­la­tions be mon­i­tored, reported and addressed with a view to pre­ven­tion and redress, in col­lab­o­ra­tion with key pop­u­la­tion-led orga­ni­za­tions; this includes pro­vid­ing HIV-sen­si­tive, read­ily avail­able, afford­able judi­cial, quasi-judi­cial and other mech­a­nisms toad­dress HIV-related human rights vio­la­tions. Bar­ri­ers such as cost, lack of legal lit­er­acy or legal rep­re­sen­ta­tion should be elim­i­nated.” (para­graph 15(e))

• “Rec­om­mend that plans and strate­gies specif­i­cally address mul­ti­ple and inter­sect­ing forms of dis­crim­i­na­tion; inter­ven­tions should be grounded in an inter­sec­tional approach, tak­ing into account the effect of stigma and dis­crim­i­na­tion on par­tic­i­pants’ iden­ti­ties, and draw in com­mu­nity lead­ers from a vari­ety of back­grounds, with a view to improv­ing the abil­ity of peo­ple to cope with inter­sec­tional dis­crim­i­na­tion and to reduce inter­nal­ized stigma.” (para­graph 23(b))

2021 Report of the Special Rapporteur on the right to health

• “The Spe­cial Rap­por­teur rec­om­mends that bio­med­ical arti­fi­cial intel­li­gence (AI) tech­nolo­gies must not per­pet­u­ate racism, sex­ism, ableism or dis­crim­i­na­tion based on sex­ual ori­en­ta­tion or gen­der. States must elim­i­nate social and polit­i­cal inequal­i­ties in order to bridge the gen­dered dig­i­tal divide, tak­ing into account the needs of peo­ple with dis­abil­i­ties, which includes offer­ing pro­tec­tions from dis­crim­i­na­tion and vio­lence related to uti­liza­tion of dig­i­tal tools and tech­nol­ogy.” (para­graph 87)

2019 OHCHR Annual report on human rights and HIV

• “States should review and adopt leg­is­la­tion, pro­grammes and poli­cies to com­bat stigma and dis­crim­i­na­tion, vio­lence and abuse against peo­ple liv­ing with or at risk of HIV, with par­tic­u­lar atten­tion to key pop­u­la­tions. States should work with United Nations agen­cies, civil soci­ety, com­mu­ni­ties and key pop­u­la­tions to invest in pro­grammes, edu­ca­tion and other actions to elim­i­nate HIV-related stigma and dis­crim­i­na­tion in all areas of life, includ­ing through the Global Part­ner­ship for Action to Elim­i­nate All Forms of HIV-related Stigma and Dis­crim­i­na­tion. Regional and sub­re­gional net­works have an impor­tant role to play in rais­ing aware­ness and elim­i­nat­ing stigma and dis­crim­i­na­tion.” (para­graph 47(g))

1999 General Recommendation No.24 on women and health

• “Mea­sures to elim­i­nate dis­crim­i­na­tion against women are con­sid­ered to be inap­pro­pri­ate if a health-care sys­tem lacks ser­vices to pre­vent, detect and treat ill­nesses spe­cific to women. It is dis­crim­i­na­tory for a State party to refuse to pro­vide legally for the per­for­mance of cer­tain repro­duc­tive health ser­vices for women. For instance, if health ser­vice providers refuse to per­form such ser­vices based on con­sci­en­tious objec­tion, mea­sures should be intro­duced to ensure that women are referred to alter­na­tive health providers.” (para­graph 11)

Evidence

2022 WHO Consolidated Guidelines on HIV, Viral Hepatitis and STI Prevention, Diagnosis, Treatment and Care for Key Populations

• “Qual­i­ta­tive research con­ducted by the global key pop­u­la­tion-led net­works for the devel­op­ment of this guide­line found that all key pop­u­la­tions reported crim­i­nal­iza­tion, stigma and dis­crim­i­na­tion as per­sis­tent bar­ri­ers to access­ing health ser­vices and remain­ing in treat­ment, as well as being dri­ving fac­tors in per­pet­u­at­ing vul­ner­a­bil­ity, human rights abuses and poor health out­comes. Par­tic­i­pants from the trans and gen­der diverse peo­ple’s net­work addi­tion­ally empha­sized struc­tural bar­ri­ers to legal gen­der recog­ni­tion.” (p. 16)

• “The effects of stigma and dis­crim­i­na­tion against key pop­u­la­tions can man­i­fest in delayed test­ing and missed diag­noses, poor reten­tion in treat­ment pro­grammes and poor treat­ment out­comes, con­ceal­ment of health sta­tus and, in gen­eral, poor uptake of health ser­vices.” (p. 20)

• “High lev­els of stigma and dis­crim­i­na­tion against trans and gen­der diverse peo­ple in health care set­tings have been widely reported. Vio­lence and stigma and dis­crim­i­na­tion increase vul­ner­a­bil­ity to sub­stance use dis­or­ders, eat­ing dis­or­ders, depres­sion, sui­cide attempts, HIV and other sex­u­ally trans­mit­ted infec­tions, among oth­ers, and com­pro­mise trans and gen­der diverse peo­ple’s access and uti­liza­tion of health ser­vices.” (p. 54)

2021 WHO Consolidated Guidelines on HIV Prevention, Testing, Treatment, Service Delivery and Monitoring

• “In HIV care, sev­eral stud­ies have shown that peo­ple are will­ing to travel longer dis­tances to con­sult a health-care provider with a respect­ful and car­ing atti­tude, and neg­a­tive health-care worker atti­tudes con­trib­ute to loss to care and poor pro­gramme out­comes. For key pop­u­la­tions in par­tic­u­lar, expe­ri­enc­ing stigma and dis­crim­i­na­tion in health-care set­tings is a struc­tural bar­rier to access­ing ser­vices.” (p. 352)

2016 Prevention Gap Report

• “Among gay men and other men who have sex with men, in 7 of 10 coun­tries with avail­able data, treat­ment cov­er­age was con­sid­er­ably lower than cov­er­age among all men liv­ing with HIV. Treat­ment cov­er­age lev­els among peo­ple who inject drugs were more sim­i­lar to cov­er­age among men gen­er­ally, but dif­fer­ences were still observed in 4 of 8 coun­tries. Female sex work­ers were also less likely to access treat­ment than the gen­eral adult female pop­u­la­tion, with just 3 of 12 coun­tries hav­ing sim­i­lar lev­els of cov­er­age. In Cam­bo­dia, trans­gen­der peo­ple had higher treat­ment cov­er­age than female sex work­ers but lower than the gen­eral adult female pop­u­la­tion.” (p. 57)