HIV/AIDS-related stigma is a complex concept that refers to prejudice, discrediting, and discrimination directed at persons perceived to have HIV or AIDS, as well as their partners, friends, family, and communities. The devaluation of people living or perceived to be living with HIV/AIDS can negatively affect HIV prevention and treatment.
Both HIV-positive and HIV-negative youth may experience multiple layers of stigma related to the aspects of their identities. For example, young men who have sex with men (MSM); lesbian, gay, bisexual, transgender, queer, and two-spirited (LGBTQ2S+) youth; and racial/ethnic minorities face stigma regardless of their HIV status. Individuals may also face stigma related to mental health, substance use, and socioeconomic status.
HIV stigma can influence youth health through various levels including individual, interpersonal, institutional, community, and policy.
HIV stigma at the individual level is often a response to social norms that disregard people living with HIV.
- Internalized stigma. Adolescents may feel shame, embarrassment, and/or guild related to their HIV status, gender identity, or sexuality.
- Fear and discomfort of status disclosure. Youth may worry that people around them will notice their HIV medications or see them accessing HIV or sexual health clinics. Sometimes when a young person shares their HIV status, it is assumed to be related to a behavior (same-sex contact, intravenous drug use) that may also be stigmatized, adding to fear and discomfort about disclosing.
- Low self-esteem and depressive symptoms. Stigma and its related stress may lead to feelings of low self-worth and harm mental health along with the overall well-being of adolescents.
Interpersonal (Family, Friends, Partners)
Stigma may be present in adolescents’ relationships with partners, friends, family, and their community.
- Judgments from others related to disclosure or status. Family, friends, partners, and others (teachers, employers, and colleagues) may express beliefs or use language that is stigmatizing. These biases may be explicit (the person is aware of their judgments) or implicit (the person may not be aware of their bias but it influences their actions).
- Partner rejection. Once youth share their status or discuss HIV with past or potential partners, they may face rejection or other negative reactions.
- Inadequate social support network. Peers and families may distance themselves from youth living or perceived to be living with HIV to avoid experiencing the same stigma they do. This rejection could be internalized as abandonment, causing someone to avoid seeking support.
Institutional (Schools, Colleges, After-School Programs, Workplaces)
At this level, stigma originates in organizations and institutions and can impact adolescent health.
- Limited discussion around sexual health. Stigma can arise when providers, educators, and other leaders do not discuss sexual health with youth. This is particularly an issue with LGBTQ2S+ youth who may not receive inclusive sex education.
- Negative attitudes or beliefs surrounding HIV. If people working at the institutional level have negative or uninformed attitudes and beliefs about HIV, it can manifest as a stigma in their interactions.
- Lack of culturally appropriate environments. Settings that do not make a person’s culture or background into consideration can yield a stigma that affects young people of various cultures and ethnicity, LGBTQ2S+ youth, and MSM.
Community: Social/Cultural Influences, Availability of Resources
Stigma at the community level can affect youth through social/cultural influences and availability of resources.
- Cultural norms and traditions. Social stigma around being HIV-positive can be intensified by attention being further drawn to an adolescent’s sexuality, gender identity, ethnicity, class, and culture. Traditional community norms, cultural/social standards, and gender roles can contribute to reinforcing stigma around HIV and leading youth to internalize it.
- Lack of HIV prevention services in broad health and commu