This discussion paper investigates the state of HIV-related stigma in New South Wales, its impacts, and how it can be addressed to improve outcomes not only for those who are directly affected by it – people living with HIV – but also to enhance efforts to end HIV transmissions for all. 

Despite leaps in anti-retroviral treatments and biomedical prevention, people living with HIV (PLHIV) in Australia continue to experience HIV-related stigma. Stigmatising behaviours take many forms, overt or subtle, online or in real life. Discrimination can occur in personal relationships and in relation to employment, insurance, accommodation and other services. HIV-related stigma is often compounded with prejudices based on sexuality, gender, race, drug use, sex work and other diseases (e.g., hepatitis C).

HIV-related stigma has real consequences on the health-related quality of life of PLHIV. Stigma leads to poorer physical and mental health outcomes. It is a barrier to accessing healthcare and may contribute to incomplete disclosure about health status and medications by patients.

HIV-related stigma also hinders efforts to end HIV transmissions for all in NSW. It acts as a barrier for HIV testing, immediate treatment initiation and adherence. Undiagnosed HIV, or late diagnoses, are persistent, and present high risks for the individual and the community as onward transmissions may continue.

This paper argues that a combination approach is required to eliminate stigma at an individual, community and structural level. This includes:

• Empowering PLHIV to build resilience and mobilise as a community to challenge stigma. This can be done by addressing anticipated, perceived and internalised stigma.
• Changing attitudes towards HIV and PLHIV. This includes programs to improve HIV literacy and dispel myths about HIV, connect HIV-positive and HIV-negative people, develop skills to recognise and address stigma, and promote positive representations.
• Having a legal environment that is informed by public health evidence and conducive to community education is vital. This means keeping strong anti-discrimination protections, refuting proposed legislation that is not evidence-based and likely to strengthen stigma by promoting outdated and incorrect information about HIV, adequately funding care services, including aged care, and repealing laws that discriminate against key populations affected by HIV (drug laws and immigration laws).