Centre for Social Research in Health, UNSW Sydney, Sydney, NSW, 2052, Australia.
National Association of People With HIV Australia (NAPWHA), Sydney, Australia.
Harm Reduct J. 2022 Jul 7;19(1):74. doi: 10.1186/s12954-022-00658-w.
Delivery of effective health care is hampered by stigma, the social processes that attach negative judgement and response to some attributes, conditions, practices and identities. Experiencing or anticipating stigma can lead to a range of practical impacts, including avoidance of health care. While we are concerned about the stigma that is attached to HIV, this commentary makes the argument that the health system is burdened by stigma of many origins.
Reducing stigma is a key issue in improving quality of health care. Our focus on HIV is about providing better care in a non-judgemental, respectful and dignified manner which enhances the health and well-being of individuals as well as delivering benefit to society at large through better population health outcomes. However, the same could be said for the numerous possible attributes, conditions, practices and identities that attract stigma. It is unrealistic to expect health systems to respond to siloed appeals for change and action. A unifying logic is needed to propel concerns about stigma to the front of the queue for action by health systems.
This commentary suggests the need for a universal precautions approach to stigma in health care, that focuses on recognising that all people may experience stigma and discrimination targeted at one or more aspects of their identities, attributes, practices and health conditions. Drawing on health system precepts of equity, access and quality of care, we argue that a universal precautions approach to reducing stigma of all origins can effect everyday aspects of policy, procedure and practice to improve outcomes for individuals and for population health.
有效的医疗服务提供受到污名化的阻碍，污名化是指将负面判断和反应附加到某些属性、状况、实践和身份上的社会过程。经历或预期污名将导致一系列实际影响，包括避免医疗保健。虽然我们关注与 HIV 相关的污名，但本评论认为，卫生系统还受到多种来源的污名的困扰。
减少污名化是改善医疗保健质量的关键问题。我们对 HIV 的关注是提供非评判、尊重和有尊严的护理，以增强个人的健康和福祉，并通过改善人口健康结果为整个社会带来益处。然而，同样的情况也可能发生在吸引污名的众多可能属性、状况、实践和身份上。期望卫生系统对针对特定问题的呼吁做出回应是不现实的。需要一种统一的逻辑，将对污名的关注推向卫生系统采取行动的前列。
本评论认为，需要在医疗保健中采取普遍预防措施来应对污名，这需要认识到所有人都可能经历针对其身份、属性、实践和健康状况的一个或多个方面的污名和歧视。借鉴卫生系统公平、可及性和护理质量的原则，我们认为，采取普遍预防措施来减少各种来源的污名，可以影响政策、程序和实践的日常方面，以改善个人和人口健康的结果。
