Department of Psychology, Hunter College, New York, New York, USA.
Basic and Applied Social Psychology, The Graduate Center of the City University of New York, New York, New York, USA.
J Int AIDS Soc. 2022 Jul;25 Suppl 1(Suppl 1):e25930. doi: 10.1002/jia2.25930.
There is robust evidence that stigma negatively impacts both people living with HIV and those who might benefit from HIV prevention interventions. Within healthcare settings, research on HIV stigma has focused on intra-personal processes (i.e. knowledge or internalization of community-level stigma that might limit clients' engagement in care) or inter-personal processes (i.e. stigmatized interactions with service providers). Intersectional approaches to stigma call us to examine the ways that intersecting systems of power and oppression produce stigma not only at the individual and interpersonal levels, but also within healthcare service delivery systems. This commentary argues for the importance of analysing and disrupting the way in which stigma may be (intentionally or unintentionally) enacted and sustained within HIV service implementation, that is the policies, protocols and strategies used to deliver HIV prevention and care. We contend that as HIV researchers and practitioners, we have failed to fully specify or examine the mechanisms through which HIV service implementation itself may reinforce stigma and perpetuate inequity.
We apply Link and Phelan's five stigma components (labelling, stereotyping, separation, status loss and discrimination) as a framework for analysing the way in which stigma manifests in existing service implementation and for evaluating new HIV implementation strategies. We present three examples of common HIV service implementation strategies and consider their potential to activate stigma components, with particular attention to how our understanding of these dynamics can be enhanced and expanded by the application of intersectional perspectives. We then provide a set of sample questions that can be used to develop and test novel implementation strategies designed to mitigate against HIV-specific and intersectional stigma.
This commentary is a theory-informed call to action for the assessment of existing HIV service implementation, for the development of new stigma-reducing implementation strategies and for the explicit inclusion of stigma reduction as a core outcome in implementation research and evaluation. We argue that these strategies have the potential to make critical contributions to our ability to address many system-level form stigmas that undermine health and wellbeing for people living with HIV and those in need of HIV prevention services.
有确凿的证据表明，污名化对艾滋病毒感染者和可能受益于艾滋病毒预防干预措施的人都有负面影响。在医疗保健环境中，艾滋病毒污名研究侧重于个人内部的过程（即对社区层面污名的了解或内化，这可能限制客户接受护理）或人际间的过程（即与服务提供者有污名化的互动）。污名的交叉方法要求我们审视权力和压迫的交叉系统不仅在个人和人际层面上产生污名的方式，而且还在医疗保健服务提供系统中产生污名的方式。本评论认为，分析和打破艾滋病毒服务实施过程中污名可能被有意或无意实施和维持的方式（即在提供艾滋病毒预防和护理时使用的政策、协议和策略）的重要性。我们认为，作为艾滋病毒研究人员和从业人员，我们未能充分说明或检查艾滋病毒服务实施本身可能加强污名化和延续不平等的机制。
我们应用 Link 和 Phelan 的五个污名组成部分（标记、刻板印象、分离、地位丧失和歧视）作为分析污名在现有服务实施中表现的框架，并评估新的艾滋病毒实施策略。我们提出了三种常见的艾滋病毒服务实施策略的例子，并考虑了它们激活污名组成部分的潜力，特别关注通过应用交叉视角如何增强和扩展我们对这些动态的理解。然后，我们提供了一组示例问题，可以用于制定和测试旨在减轻艾滋病毒特定和交叉污名的新实施策略。
本评论是对评估现有艾滋病毒服务实施、制定新的减少污名化实施策略以及明确将减少污名化作为实施研究和评估的核心结果的理论驱动的呼吁。我们认为，这些策略有可能为我们解决许多系统层面的污名问题做出重要贡献，这些污名问题破坏了艾滋病毒感染者和需要艾滋病毒预防服务的人的健康和福祉。
