Public health services and intersectional stigma: A social sciences perspective with implications for HIV service design and delivery

PURPOSE OF REVIEW: Understanding stigma is important for improving HIV care services and gaps in HIV service delivery have been attributed to stigma. This review article synthesizes recent evidence on stigma and its implications for HIV service design and delivery. Given the intersectional nature of stigma, we will focus on HIV stigma as well as related forms of stigma based on one’s race, sexual identity, gender identity and other identities. RECENT FINDINGS: Stigma remains a barrier to achieving equity in HIV services. Individualistic measures of stigma remain influential and are associated with barriers to accessing HIV health services. Recent work also highlights stigma measured at a structural level and its impact on HIV services contexts. Individuals situated at intersections of marginalized identities continue to face greatest injustices, and although intersectional approaches have been adapted to design services at a micro level, few focus on structural change. Recent evidence for mitigating stigma indicates some success for psychosocial interventions that target internalized stigma. Furthermore, community-led approaches show promise in addressing stigma that manifests in HIV health services settings. SUMMARY: Interventions that address individual-level stigma and structural stigma are needed. Theoretical and applied antistigma research is needed to make HIV services more equitable.

• Epidemiology and Determinants of Health
  • Determinants of Health
• Determinants of Health
  • Stigma/discrimination
• Population(s)
  • General HIV+ population
• Health Systems
  • Delivery arrangements