Changing social norms
The HIV community may have had some success in preventing discrimination by enacting and enforcing laws enshrining human rights in the context of HIV – and repealing those that don’t. But to combat the social phenomenon of stigma, we need a strategy that is fundamentally both social and personal in nature.
We know that various strategies work to reduce the harmful effects of stigma. For example, peer support and effectively resourcing and supporting youth-led organizations, networks of people living with HIV and organizations of key populations can aid in reaching and engaging those most affected by stigma. Likewise, strategies that effectively support individuals to overcome self-stigma and feel comfortable and confident again in themselves go a long way to promoting resilience and countering the negative impacts of stigma.
We know from the very earliest history of the HIV response that support groups and other interventions are highly effective in forging social links for people who are isolated. These are interventions that improve people’s sense of self-worth, boost their confidence, build their social capital by enabling them to have a sense of belonging to a community and provide them with the information and skills they need to make healthy choices.
We also know, not only from HIV but also from a broad array of social justice issues, that social mobilization strategies can build cohesive communities and contribute to community-sensitive service delivery. Differentiated service delivery, which builds on community needs and resources, not only has the potential to sidestep the stigma and discrimination that strikes at the heart of the integrity of mainstream health facilities, but also can empower and inspire communities.
Urgent new investments are needed to bring these proven strategies to scale. Yet at their best, these strategies are primarily aimed at mitigating the most harmful consequences of stigma. What we’ve yet to do is apply laser-like focus on fighting stigma itself.
To be successful in responses to HIV, we must engage, challenge and change hearts and minds to remove stigma.
Where judgment, exclusion and scapegoating have prevailed, we must persuade people to act with generosity, compassion and solidarity.
Although the goal of eradicating stigma in the context of HIV appears daunting, the truth is that other movements have succeeded against similar odds in changing social norms. The healthy eating movement, for example, is a model of how promoting positive messaging can shift behaviours and social norms without judging or devaluing people who are overweight. In the not-too-distant past, people diagnosed with cancer instinctively reacted with shame and secrecy, but in settings where diagnostic and treatment services are readily available, today cancer is widely accepted as a diagnosis without shame.
Let us model the change we want to see in our societies and in the world.