Intended for healthcare professionals

Rapid response to:

Opinion

HIV related stigma: a dangerous roadblock

BMJ 2022; 379 doi: https://doi.org/10.1136/bmj.o2989 (Published 12 December 2022) Cite this as: BMJ 2022;379:o2989

Rapid Response:

Re: HIV related stigma: a dangerous roadblock

Dear Editor,

We read with interest the Opinion on HIV-related stigma [1]. Accurate information is essential to tackle HIV-related stigma, but it is complex and multidimensional, including internalised stigma which was not addressed.

Internalised stigma, when an individual applies negative ideas and stereotypes to themselves, resulting in fear of potential discrimination, negatively impacts social identity and mental health [2]. Research is disappointingly scant, but peer support can reduce feelings of isolation and loneliness, and peer-support combined with routine clinical care is superior to routine medical care alone in improving outcomes for people living with HIV [3].

The opinion piece rightly highlights lack of knowledge about HIV in the population and the need healthcare professionals to be at the forefront of tackling stigma [1]. However, we must recognise the potential contribution of HIV services. Many healthcare professionals were trained when formal pre-test counselling was routine; the impact of exceptionalising HIV testing lingers. Very limited provision of routine HIV care beyond specialist services limits experience for the wider medical profession, as does avoidance of NHS numbers and shared care records. Whilst we support the right of people with HIV to choose whether to share their diagnosis, it is perhaps unrealistic to expect to eliminate stigma if we don’t facilitate seamless collaboration across the health and social care sectors.

London’s Fast Track Cities Initiative is laudable but focus on urban settings risks leaving lower prevalence rural settings behind; to achieve equity the whole nation must have equitable access to these initiatives and the funding they attract. Zero tolerance for stigma, focused not only on HIV but all conditions and characteristics associated with discrimination, and better integration of HIV testing, prevention and treatment into all healthcare settings will go a long way to achieving the HIV Action Plan goals of zero HIV-related stigma by 2030 [5].

References

1. Anderson J & Fenton K. HIV related stigma: a dangerous roadblock. BMJ 2022;379:o2989.
doi.org/10.1136/bmj.o2989
2. Corrigan PW & Rao D. On the Self-Stigma of Mental Illness: Stages, Disclosure, and Strategies for Change. Can J Psychiatry. 2012 Aug;57:464–469.
doi: 10.1177/070674371205700804
3. Berg RC, Page S, Øgård-Repål A. The effectiveness of peer-support for people living with HIV: A systematic review and meta-analysis. PLoS One 2021 Jun 17;16:e0252623. doi: 10.1371/journal.pone.0252623
4. Ware NC, Wyatt MA, Tugenberg T. Social relationships, stigma and adherence to antiretroviral therapy for HIV/AIDS. AIDS Care. 2006;18:904–10.
doi: 10.1016/j.socscimed.2004.12.015.
5. Department of Health and Social Care. Towards zero: the HIV action plan for England: 2022 to 2025. www.gov.uk/government/publications/towards-zero-the-hiv-action-plan-for-....

Competing interests: MB and LW have no competing interests related to this piece. They both have received speaker and adviser fees from ViiV, Gilead, Janssen, MSD.

24 December 2022
Marta Boffito
Consultant Physician in ID/HIV Medicine
Laura Waters
Chelsea and Westminster Hospital
369 Fulham Road