Due perhaps to the current focus on social drivers of the HIV epidemic, stigma - against those infected and affected by HIV, TB patients, MSM, and CSW - was much discussed in Mexico City. So why aren't we doing a better job addressing it? In an inspiring presentation on Wednesday, Edwin Cameron of South Africa's High Court observed that, while we know a good deal about the external manifestations of stigma, we are less well informed about the internal dimension of the problem - how stigma works in the mind of a person who has or fears s/he has HIV. Cameron also posited that we may be further stigmatizing HIV by "making exceptions" around counseling and testing rather than routinizing it in the way we have diagnostics for other health conditions. Both of these points, should one subscribe to them, have important implications for communication around stigma, which has tended to be broadly targeted, proscriptive, and solidly focused on "external" stigma.
In practical terms, we could stand to better adhere to best practices in stigma reduction programming, which are now well established. These include involving gatekeepers early; cultivating multiple change agents; using a range of intervention approaches and communication channels; addressing multiple "layers" of stigma (stigma around HIV, homophobia, stigma around TB, etc); and perhaps most importantly, giving PLWHA both a central role and a safe space to address internal stigma before acting as advocates.
Why is this so important now, for those of us in the world of communication? Stigma continues to undermine the success of interventions in all domains of HIV/AIDS programming, from service promotion, to prevention, to treatment uptake and adherence. Addressing stigma should be, as one speaker on Wednesday's panel pointed out, the complement to all other HIV/AIDS interventions - enhancing their efficacy by providing a solid social foundation for individual behavior change.