A letter to Public Health
Stigma and discrimination fundamentally impede the fight against HIV and AIDS, as well as PrEP uptake amongst people of color. The social determinant operates through mechanisms such as avoidance of care due to fear of rejection or denied healthcare. Therefore, achieving equitable HIV outcomes requires prioritizing anti-stigma campaigns and integrating family support systems to help create a trustworthy environment, in and out of the home.
Human Immunodeficiency Virus or (HIV) infection and Acquired Immune Deficiency Syndrome (AIDS), alongside low rates of access to prevention tools like Pre-exposure Prophylaxis (PrEP), particularly among Black and Latino men who have sex with men (BLMSM) (Boyd et al., 2022). The social determinants of stigma and discrimination create a structural barrier that undermines treatment and prevention efforts (Boyd et al., 2022; Anderson-Minshall, n.d.). The stigma surrounding HIV, often fueled by internalized homophobia and the fear of being rejected, prevents people from seeking care. Additionally, outdated laws that criminalize HIV status only add to this stigma, making it even more challenging to participate in discussions about HIV and prevention methods.
Stigma and discrimination create harmful barriers that seriously undermine HIV prevention and treatment efforts, which can lead to a higher risk of HIV transmission (Anderson-Minshall, n.d.; Guzman Herrera et al., 2024). Reilly et al. (2021) conducted a cross-sectional study, finding that HIV-positive status is independently associated with reports of having been denied or given lower quality of care. This finding illustrates how institutional discrimination perpetuates mistrust, reinforcing the cycle of care avoidance. HIV stigma is associated with lower rates of medication adherence, viral suppression, and retention in care (Guzman Herrera et al., 2024), demonstrating that stigma has biological consequences. Similarly, individuals facing severe social challenges exacerbated by stigma, such as homelessness, are less likely to have access to and adhere to their prescriptions (Anderson-Minshall, n.d.). This has public health implications because medical science recognizes that U=U (undetectable equals untransmittable) (Anderson-Minshall, n.d.). In other words, the effects of stigma go beyond the individual and sustain community-level transmission. Therefore, the stigma-driven failure to access and adhere to treatment results in a detectable viral load, fuelling the ongoing epidemic (Anderson-Minshall, n.d.).
Operating at an individual level, internalized homophobia and fear of rejection drive individuals to conceal their sexual identity, leading to an avoidance of medical care essential for services like PrEP, a mechanism strongly associated with lower PrEP interest and uptake (Boyd et al., 2022). At the community and structural levels, experiences of discrimination, such as being denied quality of care, are directly linked to HIV-positive status, demonstrating how social exclusion creates persistent barriers even where healthcare is advanced (Reilly et al., 2021). To effectively address public health issues, launching anti-stigma campaigns and providing thorough sexual health education can help alleviate fear. Such measures will enable individuals affected to speak with providers and families to address their concerns. Additionally, supporting LGBTQ-friendly clinics and ensuring that healthcare providers receive appropriate training are vital steps toward providing competent care and restoring trust within marginalized communities (Guzman Herrera et al., 2024).
The social determinant is active through mechanisms such as the avoidance of care due to fear of rejection or denial of healthcare. Ultimately, addressing the stigma requires more than awareness; it needs structural reform in healthcare training and policy. To combat this determinant, achieving equitable HIV outcomes requires prioritizing anti-stigma campaigns and integrating family support systems to help create a trustworthy environment, in and out of the home.
