Stigmatisation and discrimination

The word stigma comes from the Greek word meaning a mark of disgrace or shame.[10]  
Stigmatisation can lead to discrimination resulting in unequal or unjust outcomes.[11]
HIV-related stigma derives from association with the ways transmission occurs, such as sex between men, sharing drug injecting equipment, and sexual transmission per se.[12] [13] HIV-related discrimination has been defined as:

Unfavourable treatment on the basis of known or imputed HIV status; action or inaction that results in people being denied full or partial access to otherwise generally available services or opportunities because of known or imputed HIV status.[14]

Discrimination can be further described as direct and active (intentional and planned) – such as the placing of alerts on an HIV-positive person’s file, or refusing to care for a person with HIV.  Alternatively, discrimination may be indirect and passive – such as the establishment of rules, policies or conditions that in themselves do not appear discriminatory but which result in discrimination against those who are unable to meet the required conditions.[15] For example, generic intake practices where a person is asked their diagnosis over the phone might indirectly discriminate by reducing access for people with HIV who are reluctant to disclose their HIV diagnosis to strangers and who may, therefore, avoid contacting a service.

Internationally and within Australia, numerous studies have found that people with HIV experience discrimination by nurses in health care, ranging from prejudicial attitudes, lack of eye contact, brusque speech, the use of excessive infection control precautions or inconsistencies around the use of standard precautions, denial of care, modifying care (e.g. not taking blood, not touching patients).[16] Women with HIV who are pregnant or trying to become pregnant have been judged more harshly than others, and have been frequently labelled drug users or sex workers, with assumptions being made about their lives.[17]

The 2019 Australian Futures Survey indicated more than half (56.6%) of the respondents living with HIV reported at least one experience of HIV-related stigma or discrimination in the past 12 months. More than one third (38.0%) reported they had been treated differently by a healthcare worker due to their HIV in the past 12 months. .[18] Common forms of stigma and discrimination include avoidance, confidentiality problems, and increased infection control measures. Experiences of stigma and discrimination are common within the health setting; meaning the care and treatment of people living with HIV remains an important subject for nursing ethics.