Discrimination against people with HIV/AIDS

{{short description|none}} <!-- "none" is preferred when the title is sufficiently descriptive; see WP:SDNONE --> {{Globalize|1=article|2=United States|date=April 2024}} People living with HIV/AIDS (PLHIV) face prejudice, fear, rejection, and stigmatization. Marginalized, at-risk groups such as members of the LGBTQ+ community, intravenous drug users, and sex workers are most vulnerable to facing HIV/AIDS discrimination. The consequences of societal stigma against PLHIV are quite severe, as HIV/AIDS discrimination actively hinders access to HIV/AIDS screening and care around the world.<ref>{{cite journal | vauthors = Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, Szekeres G, Coates TJ | display-authors = 6 | title = Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward | journal = AIDS | volume = 22 | issue = Suppl 2 | pages = S67-79 | date = August 2008 | pmid = 18641472 | pmc = 2835402 | doi = 10.1097/01.aids.0000327438.13291.62 }}</ref> Moreover, these negative stigmas become used against members of the LGBTQ+ community in the form of stereotypes held by physicians.<ref>{{Cite journal |last1=Stringer |first1=Kristi L. |last2=Turan |first2=Bulent |last3=McCormick |first3=Lisa |last4=Durojaiye |first4=Modupeoluwa |last5=Nyblade |first5=Laura |last6=Kempf |first6=Mirjam-Colette |last7=Lichtenstein |first7=Bronwen |last8=Turan |first8=Janet M. |date=2016 |title=HIV-Related Stigma Among Healthcare Providers in the Deep South |journal=AIDS and Behavior |language=en |volume=20 |issue=1 |pages=115–125 |doi=10.1007/s10461-015-1256-y |pmid=26650383 |pmc=4718797 |issn=1090-7165}}</ref>

HIV/AIDS discrimination takes many forms such as blood donation restrictions on at-risk populations, compulsory HIV testing without prior consent, violations of confidentiality within healthcare settings, and targeted violence against PLHIV. In addition, HIV discrimination is a global issue that affects individuals despite respective nation laws prohibiting HIV/AIDS discrimination.<ref>{{Citation |last1=Swinkels |first1=Helena M. |title=HIV and AIDS |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK534860/ |access-date=2025-02-28 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=30521281 |last2=Justiz Vaillant |first2=Angel A. |last3=Nguyen |first3=Andrew D. |last4=Gulick |first4=Peter G.}}</ref><ref>{{Cite web|title=Civil Rights|url=https://www.hiv.gov/hiv-basics/living-well-with-hiv/your-legal-rights/civil-rights|date=2017-11-10|website=HIV.gov|language=en|access-date=2018-04-10}}</ref> HIV/AIDS discrimination lowers the chances of PLHIV to seek help, and can affect advancement of treatments.<ref>{{cite journal | vauthors = Parker R, Aggleton P | title = HIV and AIDS-related stigma and discrimination: a conceptual framework and implications for action | journal = Social Science & Medicine | volume = 57 | issue = 1 | pages = 13–24 | date = July 2003 | pmid = 12753813 | doi = 10.1016/S0277-9536(02)00304-0 }}</ref> <ref name=":04">{{Cite web|publisher=World Health Organization|date=2004|title=Violence Against Women and HIV/AIDS: Critical Intersections. Intimate Partner Violence and HIV/AIDS|url=https://www.who.int/hac/techguidance/pht/InfoBulletinIntimatePartnerViolenceFinal.pdf?ua=1}}</ref>

== HIV-related stigma == HIV stigma is a negative opinion or belief towards people with HIV.<ref name=":15">{{Cite web |last=CDC |date=2024-05-08 |title=Stigma and HIV |url=https://www.cdc.gov/hiv/health-equity/index.html |access-date=2026-02-27 |website=HIV |language=en-us}}</ref> HIV discrimination is a negative action or behavior towards people with HIV that stem from HIV stigma. <ref name=":15" /> HIV/AIDS stigma is divided into the following three categories: * Instrumental AIDS stigma: A reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.<ref name="Herek1999">{{cite journal| vauthors = Herek GM |year=1999|title=AIDS and stigma in the United States. [Special issue]|journal=American Behavioral Scientist|volume=42|issue=7}}</ref> * Symbolic AIDS stigma: The use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.<ref name="Herek1999"/> * Courtesy AIDS stigma: Stigmatization of people connected to the issue of HIV/AIDS or HIV-positive people.<ref>{{Cite journal |last=Parks |first=Fayth M. |last2=Smallwood |first2=Stacy W. |date=2021-04-03 |title=Courtesy stigma and self-care practices among rural HIV/AIDS healthcare providers |url=https://www.tandfonline.com/doi/full/10.1080/15381501.2021.1922116 |journal=Journal of HIV/AIDS & Social Services |language=en |volume=20 |issue=2 |pages=136–143 |doi=10.1080/15381501.2021.1922116 |issn=1538-1501|url-access=subscription }}</ref>

PLHIV may also experience internalized stigma.<ref>{{Cite journal |last1=Turan |first1=Bulent |last2=Budhwani |first2=Henna |last3=Fazeli |first3=Pariya L. |last4=Browning |first4=Wesley R. |last5=Raper |first5=James L. |last6=Mugavero |first6=Michael J. |last7=Turan |first7=Janet M. |date=2017 |title=How Does Stigma Affect People Living with HIV? The Mediating Roles of Internalized and Anticipated HIV Stigma in the Effects of Perceived Community Stigma on Health and Psychosocial Outcomes |journal=AIDS and Behavior |language=en |volume=21 |issue=1 |pages=283–291 |doi=10.1007/s10461-016-1451-5 |pmid=27272742 |pmc=5143223 |issn=1090-7165}}</ref> Internalized stigma is when a person applies negative ideas or stereotypes about HIV towards themselves. This can lead to feelings of shame or isolation. Internalized stigma can increase the fear that an HIV diagnosis will be disclosed, and subsequently, increase fear of discrimination or lack of acceptance due to the HIV positive status.<ref name=":2">{{Cite web|date=2020-10-22|title=Facts about HIV Stigma {{!}} HIV Basics {{!}} HIV/AIDS {{!}} CDC|url=https://www.cdc.gov/hiv/basics/hiv-stigma/index.html|access-date=2021-04-08|website=www.cdc.gov|language=en-us}}</ref> UNAIDS, in a study across 25 countries, reports 85% of people experience internalized stigma.<ref name=":14">{{Cite web |title=Zero Discrimination Day 2026 {{!}} UNAIDS |url=https://www.unaids.org/en/2026-zero-discrimination-day |access-date=2026-02-27 |website=www.unaids.org |language=en}}</ref> HIV-related stigma and discrimination can negatively impact the mental health of people living with HIV.<ref name=":2" />

Stigma towards people living with HIV is widespread. In 35 percent of countries with available data, UNAIDS reports 50 percent of people admitted to having stigma towards people living with HIV.<ref>{{Cite web|date=2015-07-20|title=HIV Stigma and Discrimination|url=https://www.avert.org/professionals/hiv-social-issues/stigma-discrimination|access-date=2021-04-08|website=Avert|language=en}}</ref><ref name=":13">{{cite web | title=On the Fast-Track to end AIDS by 2030: Focus on location and population | website=UNAIDS | date=2015-11-24 | url=https://www.unaids.org/en/resources/documents/2015/FocusLocationPopulation | access-date=2024-06-29}}</ref> The People Living with HIV Stigma Index (PLHIV Stigma Index) exists as a tool to collect evidence on the prevalence and impact of stigma and discrimination towards people living with HIV. The PLHIV Stigma Index was developed by GNP+, ICW, UNAIDS and IPPF in 2008, and is utilized in over 100 countries.<ref>{{Cite web|title=What is the People Living with HIV Stigma Index?|url=https://www.stigmaindex.org/about-the-stigma-index/what-is-the-people-living-with-hiv-stigma-index/|access-date=2021-04-08|website=People Living with HIV Stigma Index|language=en-GB|archive-date=2021-04-17|archive-url=https://web.archive.org/web/20210417224122/https://www.stigmaindex.org/about-the-stigma-index/what-is-the-people-living-with-hiv-stigma-index/|url-status=dead}}</ref> Individual country reports of the PLHIV Stigma Index are available from 2016 and beyond.<ref>{{Cite web|title=Country Reports|url=https://www.stigmaindex.org/country-reports/|access-date=2021-04-26|website=People Living with HIV Stigma Index|language=en-GB}}</ref>

=== Domestic stigmatization === Domestic stigmatization refers to HIV-related stigma that takes place within the home or familial environment. This form of stigma is distinct from institutional or healthcare stigma because it occurs in private, interpersonal contexts, often involving family members, romantic partners, neighbors, or live-in caregivers. Examples include being isolated within the home, denied access to shared household items, forcibly evicted by relatives, or subjected to verbal or physical abuse due to one’s HIV status.<ref>{{Cite journal |last=Andrasik |first=Michele |last2=Broder |first2=Gail |last3=Oseso |first3=Linda |last4=Wallace |first4=Stephaun |last5=Rentas |first5=Francisco |last6=Corey |first6=Lawrence |date=2019-12-04 |title=Stigma, Implicit Bias, and Long-Lasting Prevention Interventions to End the Domestic HIV/AIDS Epidemic |url=https://pmc.ncbi.nlm.nih.gov/articles/PMC6893342/ |journal=American Journal of Public Health |volume=110 |issue=1 |pages=67–68 |doi=10.2105/AJPH.2019.305454 |issn=1541-0048 |pmc=6893342 |pmid=31800273}}</ref>

A 2020 review of 37 studies across multiple countries identified 51 distinct acts of domestic stigmatization reported by PLHIV, with women disproportionately affected. These experiences were linked to microaggressions, emotional distress, and withdrawal from social or medical support systems. The study emphasizes the need for stigma-reducing interventions that target family dynamics and domestic spaces, where support is often assumed but not always present.<ref>{{Cite web |title=Taylor & Francis Online |url=https://www.tandfonline.com/action/cookieAbsent |access-date=2026-05-22 |website=www.tandfonline.com |doi=10.2989/16085906.2020.1834416}}</ref>

People living with HIV face discrimination in many sectors, including healthcare, education, employment, and law enforcement.<ref name=":13" /> Discrimination takes the form of denial of services, lack of accessible services for key populations, and insufficient funding and scale for services.<ref name=":13" /> In conjunction to internalized stigma, HIV/AIDS stigma and discrimination make it more difficult for PLHIV to feel comfortable in obtaining the medical services they need.<ref>{{Cite web|last1=Mirza|first1=Shabab Ahmed|last2=Rooney|first2=Caitlin|date=2018-01-18|title=Discrimination Prevents LGBTQ People From Accessing Health Care|url=https://www.americanprogress.org/issues/lgbtq-rights/news/2018/01/18/445130/discrimination-prevents-lgbtq-people-accessing-health-care/|access-date=2021-04-08|website=Center for American Progress|language=en-US}}</ref>

== Misconceptions about HIV in the US == [[File:AIDS march 2 1990 aids protest Evansdale.jpg|thumb|Protest against the opening of an AIDS hospice in Evansdale, Iowa, 3 March 1990]] Today, there continues to be significant misconceptions about HIV within the US. Furthermore, misconceptions about the transmission of HIV promotes fear amongst many members of society, and this often translates into biased and discriminatory actions against PLHIV.<ref>{{cite journal | vauthors = Waite KR, Paasche-Orlow M, Rintamaki LS, Davis TC, Wolf MS | title = Literacy, social stigma, and HIV medication adherence | journal = Journal of General Internal Medicine | volume = 23 | issue = 9 | pages = 1367–72 | date = September 2008 | pmid = 18563494 | pmc = 2518013 | doi = 10.1007/s11606-008-0662-5 }}</ref>

A 2009 study conducted by the Kaiser Family Foundation found that many Americans still lack basic knowledge about HIV.<ref name=":42">{{Cite web|title=2009 Survey of Americans on HIV/AIDS: Summary of Findings on the Domestic Epidemic|url=https://www.kff.org/hivaids/poll-finding/2009-survey-of-americans-on-hivaids-summary/|date=2009-04-02|website=The Henry J. Kaiser Family Foundation|language=en-US|access-date=2020-04-27}}</ref> According to the survey, a third of Americans believe that HIV could be transmitted through sharing a drink or touching a toilet used by an HIV-positive individual.<ref name=":42" /> Furthermore, the study reported that 42 percent of Americans would be uncomfortable with having an HIV-positive roommate, 23 percent would be uncomfortable with an HIV-positive coworker, 50 percent would be uncomfortable with an HIV-positive person preparing their food, and 35 percent would be uncomfortable with their child having an HIV-positive teacher.<ref name=":42" /> Many of the respondents who were able to correctly answer questions about HIV transmission still reported similar biased views against HIV-positive individuals; in fact, 85 percent of these respondents reported that they would feel uncomfortable working with an HIV-positive coworker.<ref name=":42" />

Some of the misconceptions about HIV within the US could result from a failure to prevent misinformation from spreading and a lack of accurate information being published. "The lack of adequate resources devoted to AIDS in the early days of the epidemic curtailed surveillance efforts and epidemiological studies at the C.D.C. and markedly hampered the biomedical research community's ability to respond."<ref>{{cite book |last1=Arno |first1=Peter S. |chapter=Local policy responses to the AIDS epidemic: New York and San Francisco |date=1989 |chapter-url=http://dx.doi.org/10.1007/978-1-4613-0807-2_3 |title=Acquired Immunodeficiency Syndrome |pages=11–19 |access-date=2023-05-01 |place=Boston, MA |publisher=Springer US |isbn=978-1-4612-8092-7 |last2=Hughes |first2=Robert G.|doi=10.1007/978-1-4613-0807-2_3 }}</ref>

=== Misconceptions about transmission of HIV === The only way that HIV can be transmitted from one individual to the next is by sharing of certain bodily fluids such as semen, blood, and vaginal discharge which the virus uses as a medium to enter the bloodstream of the recipient; HIV is not transmissible via fluids such as saliva, sweat, tears, or urine as it is not in high enough concentrations to spread in these matters.<ref name="cdc.gov">{{Cite web|date=2019-09-25|title=HIV Transmission {{!}} HIV Basics {{!}} HIV/AIDS {{!}} CDC|url=https://www.cdc.gov/hiv/basics/transmission.html|access-date=2020-06-30|website=www.cdc.gov|language=en-us}}</ref> In order for HIV to enter another person, either the semen, blood, or vaginal discharge must find an entry point by way of injection, unprotected sex, or during pregnancy as the mother can pass it along; one would only contract the virus when coming in direct contact with these fluids, for example, with an open cut on the skin that exposes blood.<ref name="cdc.gov"/>

PLHIV do not always pass on the virus to someone else when engaging in sexual activities or sharing bodily fluids; PLHIV can have no transmission risk by taking medication which lowers the amount of HIV virus present in the bloodstream, rendering the individual as having an undetectable viral load.<ref>{{Cite web|date=2020-04-06|title=HIV Treatment as Prevention {{!}} HIV Risk and Prevention {{!}} HIV/AIDS {{!}} CDC|url=https://www.cdc.gov/hiv/risk/art/index.html|access-date=2020-06-30|website=www.cdc.gov|language=en-us}}</ref> Pre-exposure prophylaxis (PrEP), on the other hand, is a drug that is used regularly as a preventative measure against HIV for those who are at a higher risk of contracting the virus but does not cure someone who has HIV.<ref>{{Cite web|date=2020-06-04|title=PrEP {{!}} HIV Basics {{!}} HIV/AIDS {{!}} CDC|url=https://www.cdc.gov/hiv/basics/prep.html|access-date=2020-06-23|website=www.cdc.gov|language=en-us}}</ref>

People can not contract AIDS, rather they are infected with HIV which progresses into AIDS over time when left unchecked; if someone has HIV, it does not guarantee that they will develop AIDS, which is even more prevented when taking medication such as antiretroviral therapy (ART) to lower viral load.<ref>{{Cite web |date=2020-06-05|title=Symptoms of HIV|url=https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/symptoms-of-hiv|access-date=2020-06-23|website=HIV.gov|language=en}}</ref>

=== Misconceptions about at-risk populations === Tim McCaskell, a Canadian writer and HIV/AIDS advocate, explains that AIDS was seen as a political problem against marginalized people. AIDS Action Now explored how medical professionals were mistreating PLHIV patients. Furthermore, he also found out that there was a lack of funds for research or education. Doctors were not fulfilling their roles as fiduciaries for marginalized people while the public believed that the doctor-patient relationship meant remaining as neutral as possible.<ref>{{Cite web | url=https://aidsactivisthistory.ca/interviews/toronto-interviews/ | title=Toronto Interviews | date=14 October 2016 }}</ref>

Many people incorrectly believe that HIV is exclusive to gay men who have sex, but, although the risks are higher for gay and bisexual males, anyone is susceptible to contracting the virus regardless of their sexual orientation, race, age, and so forth.<ref>{{Cite web |date=2017-05-15|title=Who Is at Risk for HIV?|url=https://www.hiv.gov/hiv-basics/overview/about-hiv-and-aids/who-is-at-risk-for-hiv|access-date=2020-06-30|website=HIV.gov|language=en}}</ref> Some forms of violence such as childhood trauma, rape, and sexual assault can lead people to engage in unsafe sexual practices that could increase their chances of contracting HIV.<ref name=":1">{{Cite web|title=WHO {{!}} Violence against women and HIV|url=https://www.who.int/reproductivehealth/topics/violence/hiv/en/|access-date=2020-06-26|website=WHO}}</ref> For example, in some cases, young girls and women who experience these traumatic events become sex workers or engage in prostitution which further increases their risk of contracting HIV.<ref name=":1" />

These discriminatory views of PLHIV also persist within the medical field. A 2006 study of health professionals in Los Angeles County found that 56 percent of nursing facilities, 47 percent of obstetricians, and 26 percent of plastic surgeons had unlawfully refused to treat an HIV-positive patient, citing concerns of HIV transmission.<ref name=":52">{{Cite journal| vauthors = Sears B, Ho D |date=2006-12-01|title=HIV Discrimination in Health Care Services in Los Angeles County: The Results of Three Testing Studies|url=https://escholarship.org/uc/item/1bm2p4gv|language=en|periodical=UCLA: The Williams Institute: Other Recent Work}}</ref> Overall, this societal stigma and discrimination has exacerbated distrust towards healthcare workers within the HIV-positive population.<ref name=":52" /> The health care community therefore has an ethical duty to dispel stereotypes and misconceptions about HIV.<ref>{{cite journal | vauthors = Anderson BJ | title = HIV Stigma and Discrimination Persist, Even in Health Care | journal = The Virtual Mentor | volume = 11 | issue = 12 | pages = 998–1001 | date = December 2009 | pmid = 23207098 | doi = 10.1001/virtualmentor.2009.11.12.oped1-0912 | doi-access = free }}</ref>

== Discriminatory practices in healthcare settings == Discriminatory practices within the medical field have been found to greatly impact the health outcomes of PLHIV.<ref name=":6">{{Cite web|title=UNAIDS warns that HIV-related stigma and discrimination is preventing people from accessing HIV services|url=https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2017/october/20171002_confronting-discrimination|website=www.unaids.org|language=en|access-date=2020-05-13}}</ref> In both low-income and high-income nations, there have been several reported cases of medical providers administering low-quality care or denying care altogether to patients with HIV.<ref name=":6" /> In a 2013 study conducted in Thailand, 40.9 percent of health workers reported worrying about touching the clothing and personal belongings of patients with HIV, despite possessing the knowledge that HIV does not spread through such items.<ref name=":6" /> In a 2008 study of 90 countries, one in four PLHIV reported experiencing some form of discrimination in healthcare settings.<ref name=":6" /> Furthermore, one in five individuals with HIV reported having been denied medical care.<ref name=":6" /> Even more concerning is the impact HIV-related discrimination has had on HIV-positive women. According to the 2008 study, one in three women living with HIV have reported instances of discrimination related to their sexual and reproductive health within a healthcare setting.<ref name=":6" /> In another study of 23 countries, in every country women have reported reproductive coercion. In addition, intersectionality affects the stigma and discrimination against these women.<ref name=":14" /> Furthermore, it has been reported that many health care workers in Europe and Central Asia lack knowledge about how HIV is transmitted, leading to them avoiding physical contact with PLHIV and feeling reserved about providing care to populations with a high HIV-prevalence.<ref>{{Cite web |date=2024-07-23 |title=HIV stigma in healthcare settings: need for increased knowledge among healthcare workers and improved facility-level guidelines |url=https://www.ecdc.europa.eu/en/news-events/hiv-stigma-healthcare-settings-need-increased-knowledge-among-healthcare-workers-and |access-date=2024-10-16 |website=www.ecdc.europa.eu |language=en}}</ref>

Another common form of discrimination within healthcare settings is the disclosure of a patient's HIV status without the patient's explicit permission.<ref name=":6" /> Within many countries, an HIV-positive status can result in social exclusion, loss of social support, and decreased chances of getting married.<ref name="Pollini20112">{{cite journal | vauthors = Pollini RA, Blanco E, Crump C, Zúñiga ML | title = A community-based study of barriers to HIV care initiation | journal = AIDS Patient Care and STDs | volume = 25 | issue = 10 | pages = 601–9 | date = October 2011 | pmid = 21955175 | pmc = 3183651 | doi = 10.1089/apc.2010.0390 | series = 601-09 }}</ref> Therefore, concerns about potential breaches of confidentiality by health workers pose significant barriers to care for HIV-positive individuals. In a comprehensive study of 31 countries, one in five persons living with HIV reported instances of a health provider disclosing their HIV-positive status without consent.<ref name=":6" /> Additionally disclosure of a person's HIV status within a healthcare setting is not exclusive to patients but also poses an ethical problem for HIV positive healthcare professionals. Due to a lack of proficient knowledge and understanding of how HIV spreads from person to person some patients feel uncomfortable being treated by a PLHIV and claim they have a "right to know" if their healthcare providers have a positive diagnosis which raises ethical questions on staffs right to privacy versus the patients right for standard of care.<ref>{{Cite journal |date=May 1997 |title=Management of healthcare workers infected with hepatitis B virus, hepatitis C virus, human immunodeficiency virus, or other bloodborne pathogens. AIDS/TB Committee of the Society for Healthcare Epidemiology of America |journal=Infection Control and Hospital Epidemiology |volume=18 |issue=5 |pages=349–363 |doi=10.1086/647626 |issn=0899-823X |pmid=9154481}}</ref>

These discriminatory practices within the medical field have resulted in the delayed initiation of HIV treatment among HIV-positive individuals.<ref name="Pollini20112" /> In New York City, men who have sex with men, transgender women, and persons of color living with HIV have all reported that stigma and discrimination among medical providers was a major deterrent from entering or staying in HIV care.<ref name=":6" /> A 2011 community-based study found that the most widely reported barrier to care amongst HIV-positive individuals is fear of stigma within healthcare settings.<ref name="Pollini20112" /> HIV-positive individuals who have experienced significant HIV-related stigma are 2.4 times less likely to present for HIV care.<ref name=":6" /> Currently, as many as 20–40 percent of Americans who are HIV-positive do not begin a care regimen within the first six months of diagnosis.<ref>{{cite journal | vauthors = Mugavero MJ | title = Improving engagement in HIV care: what can we do? | journal = Topics in HIV Medicine | volume = 16 | issue = 5 | pages = 156–61 | date = December 2008 | pmid = 19106431 }}</ref> Overall, this perpetuation of HIV discrimination has been detrimental to the health outcomes of HIV-positive individuals, as patients who begin treatment late in the progression of HIV have a 1.94 times greater risk of mortality in comparison to those who start treatment at the onset of diagnosis, suggesting that HIV treatment delays stemming from fears of discrimination may have fatal consequences.<ref name=":7">{{cite news|publisher=Panel on Antiretroviral Guidelines for Adults and Adolescents|date=October 14, 2011|title=Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents|newspaper=Department of Health and Human Services}}</ref>

=== Blood donation restrictions on at-risk populations === Between 1970 and 1980, more than 20,000 HIV infections were attributed to contaminated blood transfusions.<ref name=":0">{{cite journal |vauthors=Karamitros G, Kitsos N, Karamitrou I |date=2017-06-08 |title=The ban on blood donation on men who have sex with men: time to rethink and reassess an outdated policy |journal=The Pan African Medical Journal |volume=27 |page=99 |doi=10.11604/pamj.2017.27.99.12891 |pmc=5554671 |pmid=28819520}}</ref> The lack of sensitive blood screening methods for HIV detection prompted the enactment of lifetime bans on blood donations from men who have sex with men (MSM), sex workers, and intravenous drug users, as these population groups were viewed to be at high risk of contracting HIV.<ref name=":0" /> At the time, this policy was viewed by health professionals as an emergency measure to prevent the contamination of the general blood supply. Multilateral institutions such as the World Health Organization (WHO) actively promoted the enactment of lifetime bans in efforts to mitigate transfusion-related HIV infections.<ref name=":0" /> This ban was adopted by the US, as well as several European countries in the 1980s.<ref name=":0" />

The blood donation ban on MSM and transgender women, in particular, has provoked substantial criticism. Members of the LGBTQ+ community view these laws as discriminatory and homophobic.<ref name=":12">{{Cite web |date=2018-11-28 |title=Ban the Ban: An argument against the 12 month blood donation deferral for men who have sex with men |url=https://www.glaad.org/amp/ban-ban-argument-against-12-month-blood-donation-deferral-men-who-have-sex-men |access-date=2020-04-06 |website=GLAAD |language=en |archive-date=2020-03-31 |archive-url=https://web.archive.org/web/20200331043129/https://www.glaad.org/amp/ban-ban-argument-against-12-month-blood-donation-deferral-men-who-have-sex-men |url-status=dead }}</ref> A significant criticism of the blood donation restrictions is that healthcare workers treat the LGBTQ+ community as a homogenous population that engages in similar sexual practices and behaviors.<ref name=":12" /> However, like any other population, MSM vary greatly in the number of sexual partners they have and in their engagement in high-risk sexual behaviors.<ref name=":12" /> Overall, the donation ban on MSM and transgender women has further exacerbated growing distrust of the medical system within the LGBTQ+ community, especially given the history of homophobia within the medical profession.<ref name=":0" /> As a result of these policies, LGBTQ+ individuals have felt substantial pressure to conceal their sexual orientation from medical providers and healthcare personnel.<ref name=":0" />

Blood banks today utilize advanced serological testing technologies with close to 100% sensitivity and specificity.<ref name=":0" /> Currently, the risk of HIV-contaminated blood infection is 1 per 8-to-12 million donations, thus demonstrating the effectiveness of modern HIV screening technologies.<ref name=":0" /> Despite these significant laboratory advances, the lifetime blood donation ban on MSM remains in several Western countries.<ref name=":0" /> Today, medical organizations such as the American Red Cross and World Health Organization are highly critical of these lifetime bans on men who have sex with men, as the epidemiology of HIV has changed drastically in the last 40 years.<ref name=":22">{{Cite web |date=September 2014 |title=Effects of Lifting Blood Donation Bans on Men Who Have Sex with Men |url=https://www.hivlawandpolicy.org/sites/default/files/Blood-Ban-update-Jan-2015.pdf |vauthors=Miyashita A}}</ref> In 2015, a mere 27% of novel HIV infections originated from the MSM population.<ref name=":0" /> In response to this epidemiological data, public health experts, medical personnel, and blood-banking organizations have called upon country governments to reform these outdated MSM blood donation policies.<ref name=":22" />

Mounting public pressure has prompted countries such as the US and UK to reform their MSM blood donation restrictions.<ref name=":22" /> In 2015, the US substituted its lifetime ban for a 12-month deferral since last MSM sexual contact, although indefinite lifetime bans remain in place for sex workers and IV drug users.<ref>{{Cite journal |author=Center for Biologics Evaluation and Research |date=2019-04-11 |title=Revised Recommendations for Reducing the Risk of Human Immunodeficiency Virus Transmission by Blood and Blood Products - Questions and Answers |url=https://www.fda.gov/vaccines-blood-biologics/blood-blood-products/revised-recommendations-reducing-risk-human-immunodeficiency-virus-transmission-blood-and-blood |archive-url=https://web.archive.org/web/20190429004555/https://www.fda.gov/vaccines-blood-biologics/blood-blood-products/revised-recommendations-reducing-risk-human-immunodeficiency-virus-transmission-blood-and-blood |url-status=dead |archive-date=April 29, 2019 |journal=FDA |language=en}}</ref> Despite these small steps in the right direction, the American Red Cross has recommended that the Food and Drug Administration (FDA) further revise its policy by adopting a three-month deferral period for MSM, as this is the current standard in countries such as Canada and the UK.<ref>{{Cite web |title=American Red Cross Statement on FDA MSM Deferral Policy |url=https://www.redcross.org/about-us/news-and-events/press-release/american-red-cross-statement-on-fda-msm-deferral-policy.html |access-date=2020-04-06 |website=www.redcross.org |language=en}}</ref> Overall, it is estimated that completely lifting the MSM blood donation ban could increase the total blood supply in the US by 2–4%, which could help save millions of lives.<ref>{{Cite web |date=2014 |title=Effects of Lifting Blood Donation Bans on Men who Have Sex with Men |url=https://williamsinstitute.law.ucla.edu/wp-content/uploads/Blood-Donation-Ban-MSM-Sep-2014.pdf |website=The Williams Institute |vauthors=Miyashita A}}</ref> Given the blood supply shortage during the COVID-19 pandemic, blood donation restrictions have recently become the subject of further criticism.<ref>{{Cite web |title=PAHO warns of potential blood shortages during the COVID-19 pandemic - PAHO/WHO {{!}} Pan American Health Organization |url=http://www.paho.org/en/news/10-4-2020-paho-warns-potential-blood-shortages-during-covid-19-pandemic |access-date=2020-04-27 |website=www.paho.org |date=10 April 2020 |language=es}}</ref>

On 2 April 2020, the FDA provided updated guidance regarding blood donation in response to the blood shortage caused by the COVID-19 pandemic. This change came following pressure from Democratic senators and LGBTQ+ rights organizations such as the Human Rights Campaign and GLAAD to reduce the 12-month deferral period for MSM and women who have sex with MSM.<ref name="abcnews.go.com">{{Cite web |title=Senators, activists urge FDA to revise blood donation policy for gay, bisexual men amid coronavirus pandemic |url=https://abcnews.go.com/Politics/senators-activists-urge-fda-revise-blood-donation-policy/story?id=69879028 |access-date=2021-04-07 |website=ABC News |language=en}}</ref> The updated guidance released by the FDA reduced the deferral period to three months, but did not meet activists' demands to base blood donation eligibility on individualized situations rather than "inaccurate stereotypes".<ref name="abcnews.go.com"/><ref>{{Cite web |author=Office of the Commissioner |date=2020-07-17 |title=Coronavirus (COVID-19) Update: FDA Provides Updated Guidance to Address the Urgent Need for Blood During the Pandemic |url=https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-provides-updated-guidance-address-urgent-need-blood-during-pandemic |archive-url=https://web.archive.org/web/20200402162015/https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-provides-updated-guidance-address-urgent-need-blood-during-pandemic |url-status=dead |archive-date=April 2, 2020 |access-date=2021-04-07 |website=FDA |language=en}}</ref> On 8 June 2020, the American Red Cross implemented these changes made by the FDA and reaffirmed in their announcement of these changes their belief that sexual orientation should not affect blood donation eligibility.<ref>{{Cite web |title=Red Cross to Implement FDA Eligibility Changes |url=https://www.redcross.org/about-us/news-and-events/press-release/2020/red-cross-to-implement-fda-eligibility-changes.html |access-date=2021-04-07 |website=www.redcross.org |language=en}}</ref> These changes catalyzed increased advocacy to end the ban against blood donations from MSM and transgender women entirely. The National LGBT Bar Association launched a "End the Gay Blood Ban" Campaign which called on the FDA to replace the current policy that singles-out MSM and transgender women with an individualized risk-based assessment, a policy currently used in countries such as Italy and Argentina. This policy would assess a potential donor's personal risk factors rather than their sexual orientation.<ref>{{Cite web |date=2020-07-20 |title=End the Blood Ban |url=https://lgbtbar.org/bar-news/end-the-blood-ban/ |access-date=2021-04-07 |website=The National LGBT Bar Association |language=en-US}}</ref> On 16 April 2020, GLAAD issued an open-letter to the FDA from over 500 infectious disease and HIV specialists, public health professionals, clinicians, healthcare administrators, trainees and researchers calling for a reevaluation of the updated guidance and the elimination of the blood ban in its entirety.<ref>{{Cite web |date=2020-04-16 |title=Open letter to FDA from medical professionals |url=https://www.glaad.org/blog/open-letter-fda-medical-professionals |access-date=2021-04-07 |website=GLAAD |language=en}}</ref>

== Violence against PLHIV == Discrimination that is violent or threatening violence stops a lot of individuals from getting tested for HIV. Violence is an important factor against the treatment of PLHIV. When PLHIV, particularly women, develop an intimate relationship, they tend not to be able to disclose to their partners of the presence of HIV in their system for fear of violence against them; this fear prevents them from receiving financial support to seek out testing, treatment, and general support from medical professionals and family members.<ref name=":04"/> A study done on PLHIV in South Africa shows that out of a study population of 500, 16.1% of participants reported being physically assaulted, with 57.7% of those resulting from one's intimate partners such as husbands and wives. The available data show high rates of participants socially isolating themselves from both friends and family, in addition to avoiding the seeking of treatment at hospitals or clinics due to increasing internalized fears.<ref>{{cite journal | vauthors = Dos Santos MM, Kruger P, Mellors SE, Wolvaardt G, van der Ryst E | title = An exploratory survey measuring stigma and discrimination experienced by people living with HIV/AIDS in South Africa: the People Living with HIV Stigma Index | journal = BMC Public Health | volume = 14 | issue = 1 | article-number = 80 | date = January 2014 | pmid = 24461042 | pmc = 3909177 | doi = 10.1186/1471-2458-14-80 | doi-access = free }}</ref>

HIV criminalization is when people living with HIV are incarcerated for non malicious HIV transmission. The intention behind HIV criminalization was to protect public health from HIV transmission, but it proved to be discriminatory towards people living with HIV. Furthermore, in the legal system, people living with HIV face discrimination and stigma; with intersectionality determining the severity of the discrimination. In some countries, HIV discrimination and criminalization is disproportional towards migrant heterosexual men. In the US and Canada, men of color are disproportionally the victims of HIV discrimination and criminalization. Thus, HIV criminalization is used as an extension of other types of stigma and discrimination toward marginalized groups.<ref>{{Cite journal |last=Bernard |first=Edwin J. |last2=Symington |first2=Alison |last3=Beaumont |first3=Sylvie |date=June 2022 |title=Punishing Vulnerability Through HIV Criminalization |journal=American Journal of Public Health |volume=112 |issue=S4 |pages=S395–S397 |doi=10.2105/AJPH.2022.306713 |issn=1541-0048 |pmc=9241463 |pmid=35763735}}</ref>

== Psychological impact of HIV discrimination == PLHIV have a higher chance of developing self-deprecating attitudes and coping skills to deal with the social repercussions of an HIV-positive diagnosis. A common concern of PLHIV is the belief that they will automatically develop AIDS and not be able to live a long, productive life as others around them. While there is no cure for HIV/AIDS, ART and other medication prevent the virus from worsening and spreading which allows for PLHIV to live longer and still establish a life or family with people.<ref>{{Cite web|title=HIV/AIDS|url=https://www.who.int/news-room/fact-sheets/detail/hiv-aids|access-date=2020-06-23|website=www.who.int|language=en}}</ref> Unfortunately, association with their condition and early death increases chances of developing a depressive state in PLHIV who may not have access to these resources.<ref name="Mental Health">{{Cite web |date=2020-03-19|title=Mental Health|url=https://www.hiv.gov/hiv-basics/staying-in-hiv-care/other-related-health-issues/mental-health|access-date=2020-06-23|website=HIV.gov|language=en}}</ref> Other related psychological impacts in PLHIV are side effects from taking ART, antiretroviral therapy. <ref name="Mental Health"/>

Negative social consequences such as stigmatization and discrimination have severe psychological implications on PLHIV: when a person chooses to disclose their status, it can lead to restricted options for marriage and even employment, which tends to worsen the mental health of these individuals and often results in a future fear of disclosure.<ref>{{Cite web|title=The Psychological Impact of HIV – AIDS 2020|url=https://www.aids2020.org/the-psychological-impact-of-hiv/|access-date=2020-06-26|language=en-US}}</ref> A meta-analysis conducted in 2021 found a strong positive correlation between HIV status and suicide rates compared to the general population, with PLHIV having 100 times higher risk of committing suicide than the general global population.<ref>{{Cite journal |last1=Pelton |first1=Matt |last2=Ciarletta |first2=Matt |last3=Wisnousky |first3=Holly |last4=Lazzara |first4=Nicholas |last5=Manglani |first5=Monica |last6=Ba |first6=Djibril M |last7=Chinchillli |first7=Vernon M |last8=Du |first8=Ping |last9=Ssentongo |first9=Anna E |last10=Ssentongo |first10=Paddy |date=April 2021 |title=Rates and risk factors for suicidal ideation, suicide attempts and suicide deaths in persons with HIV: a systematic review and meta-analysis |journal=General Psychiatry |language=en |volume=34 |issue=2 |article-number=e100247 |doi=10.1136/gpsych-2020-100247 |issn=2517-729X |pmc=8042999 |pmid=33912798}}</ref> Further analysis cited "[b]iological, psychological, social, and structural determinants" as factors for the increase.<ref>{{Cite journal |last1=Liu |first1=Yuming |last2=Songtaweesin |first2=Wipaporn Natalie |last3=Tucker |first3=Joesph D |last4=Sohn |first4=Annette H |last5=Latkin |first5=Carl A |last6=Hall |first6=Brian J |date=November 2022 |title=Suicide prevention research is crucial to achieving health equity for people with HIV |url=https://linkinghub.elsevier.com/retrieve/pii/S235230182200296X |journal=The Lancet HIV |language=en |volume=9 |issue=11 |pages=e745–e746 |doi=10.1016/S2352-3018(22)00296-X|pmid=36332651 |url-access=subscription }}</ref>

Research done in South Africa has found that the high levels of stigma experienced by HIV-positive individuals has a severe psychological impact. Internalized stigma and discrimination is severe throughout the PLHIV community, as many PLHIV in South Africa blamed themselves for their current situation.<ref>{{cite journal | vauthors = Visser MJ, Makin JD, Vandormael A, Sikkema KJ, Forsyth BW | title = HIV/AIDS stigma in a South African community | journal = AIDS Care | volume = 21 | issue = 2 | pages = 197–206 | date = February 2009 | pmid = 19229689 | pmc = 4238924 | doi = 10.1080/09540120801932157 }}</ref> Psychological support for PLHIV in certain countries around the world is scarce.<ref>{{Cite web|date=2015-07-20|title=Funding for HIV and AIDS|url=https://www.avert.org/professionals/hiv-around-world/global-response/funding|access-date=2022-02-14|website=Avert|language=en}}</ref>

A study examining the impact of discrimination on PLHIV concluded that experiencing higher levels of HIV discrimination is correlated with a depressive state and even receiving psychiatric care the previous year. Depressive symptoms have also been correlated with elevated rates of suicidal ideation, anxiety and disease progression.<ref name="APA PsycNet">{{cite journal | vauthors = Heckman TG, Anderson ES, Sikkema KJ, Kochman A, Kalichman SC, Anderson T | title = Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered, coping improvement group intervention | journal = Health Psychology | volume = 23 | issue = 1 | pages = 94–100 | date = January 2004 | pmid = 14756608 | doi = 10.1037/0278-6133.23.1.94 }}</ref> Another recent study that predominantly focused on HIV-positive African American men concluded that discrimination has a profound impact on reducing the quality of life of these individuals.<ref>{{cite journal | vauthors = Buseh AG, Kelber ST, Stevens PE, Park CG | title = Relationship of symptoms, perceived health, and stigma with quality of life among urban HIV-infected African American men | journal = Public Health Nursing | volume = 25 | issue = 5 | pages = 409–19 | date = 2008 | pmid = 18816358 | doi = 10.1111/j.1525-1446.2008.00725.x }}</ref>

Studies have also shown that PLHIV living in non-metropolitan areas of the US also experience large amounts of emotional distress. 60 percent of participants enrolled in a randomized clinical trial reported moderate or severe levels of depressive symptomatology on the Beck Depression Inventory. This is due to these participants receiving much less social support, and also due to great levels of HIV-related stigma and rejection within families.<ref name="APA PsycNet"/> Furthermore, relative to their urban counterparts, PLHIV in non-metropolitan areas experience more loneliness, a lack of sufficient healthcare and social services, and higher levels of discrimination which contribute to greater levels of emotional distress.<ref name="APA PsycNet"/>

== HIV/AIDS health disparities in marginalized groups == The US HIV epidemic has drastically evolved over the course of the last 40 years since the AIDS epidemic that started in 1981, and this disease has been rampantly widespread in socially marginalized and underrepresented communities. Statistics show that most HIV infections occur in sexual minorities and communities of color, specifically Black and Hispanics/Latinos. For example, in 2021, African Americans accounted for 40% of all new HIV infections while making up only 12% of the US population.<ref name=":3">{{cite journal | vauthors = Pellowski JA, Kalichman SC, Matthews KA, Adler N | title = A pandemic of the poor: social disadvantage and the U.S. HIV epidemic | journal = The American Psychologist | volume = 68 | issue = 4 | pages = 197–209 | date = 2013 | pmid = 23688088 | pmc = 3700367 | doi = 10.1037/a0032694 }}</ref> Similarly, 78% of HIV infections in Georgia occur among African Americans, while African Americans comprise only 30% of the overall population.<ref name=":3" /> Hall et al. (2008) found distinct incidence rates of HIV infection among African Americans (83/100,000 population) and Latinos (29/100,000), specifically when compared to whites (11/100,000).<ref name=":3" />

The single group that is consistently at the greatest risk for HIV infection happens to form the intersection of sexual orientation and racial background; MSM are the most HIV affected Americans, and African American MSM are at an HIV risk that is six times greater than that of white MSM.<ref name=":3" /> Notably, in England, racial disparities in HIV-related healthcare continue to be a pressing issue. A 2025 report by the National AIDS Trust found that 19% of Black people living with HIV in London avoided visiting their general practitioner due to fears of discrimination, while 20% reported receiving judgmental comments from healthcare staff.<ref>{{Cite news |last=Thomas |first=Tobi |date=2025-04-10 |title=GPs in England provide inadequate care for Black people with HIV, says charity |url=https://www.theguardian.com/society/2025/apr/10/gps-in-england-provide-inadequate-care-for-black-people-with-hiv-says-charity? |access-date=2025-04-19 |work=The Guardian |language=en-GB |issn=0261-3077}}</ref> These findings highlight the need for greater cultural competency among medical professionals and targeted policy interventions to address institutional racism within the UK's National Health Service. Studies suggest that people experiencing intersectional stigma face greater barriers in accessing healthcare, employment, and social support systems, further marginalizing affected individuals.<ref>{{Cite journal |last1=Karver |first1=Tahilin Sanchez |last2=Atkins |first2=Kaitlyn |last3=Fonner |first3=Virginia A. |last4=Rodriguez-Diaz |first4=Carlos E. |last5=Sweat |first5=Michael D. |last6=Taggart |first6=Tamara |last7=Yeh |first7=Ping Teresa |last8=Kennedy |first8=Caitlin E. |last9=Kerrigan |first9=Deanna |date=2022 |title=HIV-Related Intersectional Stigma and Discrimination Measurement: State of the Science |url=https://doi.org/10.2105/ajph.2021.306639 |journal=American Journal of Public Health |volume=112 |issue=S4 |pages=S420–S432 |doi=10.2105/ajph.2021.306639 |pmid=35763725 |issn=0090-0036|pmc=9241460 }}</ref> Aside from race and sexual orientation, socioeconomic status, education and employment are all equally important factors that studies link to HIV infection. The CDC reports that HIV rates are highest among groups who are at or below the poverty level; they also found that individuals who are unemployed and/or have less than a high school education are more prone to HIV infection.<ref name=":3" />

In order to help HIV infected people receive care, the first vital step revolves around HIV testing and early diagnosis. Delayed testing is highly detrimental and leads to an increased risk of HIV transmission. Currently, there are many issues associated with HIV diagnosis and lack of available testing for minorities. A study of 16 US cities found that African Americans are more likely to be tested much later for HIV infection, which places this group at a stark disadvantage for gaining access to proper treatment.<ref name=":02">{{cite journal | vauthors = Gardner EM, McLees MP, Steiner JF, Del Rio C, Burman WJ | title = The spectrum of engagement in HIV care and its relevance to test-and-treat strategies for prevention of HIV infection | journal = Clinical Infectious Diseases | volume = 52 | issue = 6 | pages = 793–800 | date = March 2011 | pmid = 21367734 | pmc = 3106261 | doi = 10.1093/cid/ciq243 }}</ref> This is problematic because a prolonged HIV infection can quickly become an AIDS diagnosis, and this can be prevented with early and frequent testing. Approximately 35–45% of those diagnosed with HIV are believed to also have AIDS at the time of testing.<ref name=":02" /> About half of the people diagnosed with HIV do not receive care in any given year, which poses a risk that they are endangering others and themselves while they are not given treatment.<ref name=":02" />

Along with race, a person's socioeconomic status prevents people from getting testing for HIV. With those who are from a lower socioeconomic status and have HIV, mortality is much higher for this population compared to those from a higher socioeconomic status.<ref>{{Cite journal |last1=Cunningham |first1=William E |last2=Hays |first2=Ron D |last3=Duan |first3=Naihua |last4=Andersen |first4=Ronald |last5=Nakazono |first5=Terry T |last6=Bozzette |first6=Samuel A |last7=Shapiro |first7=Martin F |date=November 2005 |title=The Effect of Socioeconomic Status on the Survival of People Receiving Care for HIV Infection in the United States |url=https://muse.jhu.edu/article/190545 |journal=Journal of Health Care for the Poor and Underserved |language=en |volume=16 |issue=4 |pages=655–676 |doi=10.1353/hpu.2005.0093 |pmid=16311491 |issn=1548-6869|url-access=subscription }}</ref> There are partly two barriers when it comes to income level: health insurance coverage and housing stability. With insurance coverage, those uninsured or with governmental health insurance, such as Medicaid or Medicare through the Affordable Care Act (ACA), have minimal options for testing and treatment, more specifically, ART and PrEP, respectively.<ref>{{Cite journal |last1=Abara |first1=Winston |last2=Heiman |first2=Harry J. |date=November 2014 |title=The Affordable Care Act and Low-Income People Living With HIV: Looking Forward in 2014 and Beyond |journal=Journal of the Association of Nurses in AIDS Care |language=en |volume=25 |issue=6 |pages=476–482 |doi=10.1016/j.jana.2014.05.002 |pmid=24996850 |pmc=4472370 |issn=1055-3290}}</ref> An economic study found that nearly 115,000 people living with HIV are uninsured, but then of those 115,000 people, 60,000 live in states that are not expanding coverage to people who can be eligible for Medicaid.<ref>{{Cite journal |last1=Snider |first1=Julia Thornton |last2=Juday |first2=Timothy |last3=Romley |first3=John A. |last4=Seekins |first4=Daniel |last5=Rosenblatt |first5=Lisa |last6=Sanchez |first6=Yuri |last7=Goldman |first7=Dana P. |date=March 2014 |title=Nearly 60,000 Uninsured And Low-Income People With HIV/AIDS Live In States That Are Not Expanding Medicaid |url=http://www.healthaffairs.org/doi/10.1377/hlthaff.2013.1453 |journal=Health Affairs |language=en |volume=33 |issue=3 |pages=386–393 |doi=10.1377/hlthaff.2013.1453 |pmid=24590935 |issn=0278-2715|url-access=subscription }}</ref> Various studies suggest that groups with lower socioeconomic status and lower education level are associated with poorer medication adherence.<ref>{{cite journal |vauthors=Kleeberger CA, Phair JP, Strathdee SA, Detels R, Kingsley L, Jacobson LP |date=January 2001 |title=Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the Multicenter AIDS Cohort Study |journal=Journal of Acquired Immune Deficiency Syndromes |volume=26 |issue=1 |pages=82–92 |doi=10.1097/00126334-200101010-00012 |pmid=11176272}}</ref> These individuals have also been found to be more likely to die after initiating treatment.<ref>{{Cite journal |last1=Cunningham |first1=William E |last2=Hays |first2=Ron D |last3=Duan |first3=Naihua |last4=Andersen |first4=Ronald |last5=Nakazono |first5=Terry T |last6=Bozzette |first6=Samuel A |last7=Shapiro |first7=Martin F |date=2005 |title=The Effect of Socioeconomic Status on the Survival of People Receiving Care for HIV Infection in the United States |url=https://muse.jhu.edu/article/190545 |journal=Journal of Health Care for the Poor and Underserved |volume=16 |issue=4 |pages=655–676 |doi=10.1353/hpu.2005.0093 |issn=1548-6869 |pmid=16311491 |s2cid=44461072|url-access=subscription }}</ref>

Stable housing status can be a considerable stressor for low-income people. This stressor leads to many low-income individuals, especially those who are homeless or those not able to have stable housing, not focusing on getting the medical support and treatment needed for those living with HIV and those at risk.<ref name=":8">{{Cite journal |last1=Milloy |first1=M.-J. |last2=Marshall |first2=Brandon D. L. |last3=Montaner |first3=Julio |last4=Wood |first4=Evan |date=December 2012 |title=Housing Status and the Health of People Living with HIV/AIDS |journal=Current HIV/AIDS Reports |language=en |volume=9 |issue=4 |pages=364–374 |doi=10.1007/s11904-012-0137-5 |pmid=22968432 |pmc=3693560 |issn=1548-3568}}</ref> One cohort study from interviews in Manhattan found that those who are stably housed are more likely to see their doctor daily for HIV treatment rather than those who are marginally housed or homeless.<ref>{{Cite journal |last1=Smith |first1=Meredith Y. |last2=Rapkin |first2=Bruce D. |last3=Winkel |first3=Gary |last4=Springer |first4=Carolyn |last5=Chhabra |first5=Rosy |last6=Feldman |first6=Ira S. |date=October 2000 |title=Housing status and health care service utilization among low-income persons with HIV/AIDS |journal=Journal of General Internal Medicine |language=en |volume=15 |issue=10 |pages=731–738 |doi=10.1046/j.1525-1497.2000.91003.x |pmid=11089717 |pmc=1495606 |issn=0884-8734}}</ref> This is partly due to priorities being different for those in high and low-income communities, with health coming in last and being financially stable coming in first for low-income individuals. Moreover, those experiencing homelessness are at a higher risk of exposure to HIV due to there being a correlation between being homeless and getting into drug use (i.e., sharing needles) and increased risk of partaking in sex work.<ref name=":8" /> This pre-exposure to different health behavioral risks makes testing and treatment for HIV challenging to get to those experiencing homelessness in time.

Transgender women are another population often disregarded in the HIV/AIDS discussion. Some clinics either lack the knowledge or refuse to offer gender-affirming hormone therapy alongside HIV treatment, forcing transgender women to choose between vital aspects of their healthcare.<ref>{{Cite journal |last1=Safer |first1=Joshua D. |last2=Coleman |first2=Eli |last3=Feldman |first3=Jamie |last4=Garofalo |first4=Robert |last5=Hembree |first5=Wylie |last6=Radix |first6=Asa |last7=Sevelius |first7=Jae |date=2016 |title=Barriers to healthcare for transgender individuals |journal=Current Opinion in Endocrinology, Diabetes & Obesity |language=en |volume=23 |issue=2 |pages=168–171 |doi=10.1097/MED.0000000000000227 |issn=1752-296X |pmc=4802845 |pmid=26910276}}</ref> A study of transgender women living with HIV in seven urban areas across the US found that employment discrimination was strongly linked to decreased healthcare utilization, including fewer primary care visits and lower adherence to HIV treatment.<ref>{{Cite journal |last1=Baugher |first1=Amy R. |last2=Olansky |first2=Evelyn |last3=Sutter |first3=Larshie |last4=Cha |first4=Susan |last5=Lewis |first5=Rashunda |last6=Morris |first6=Elana |last7=Agnew-Brune |first7=Christine |last8=Trujillo |first8=Lindsay |last9=Respress |first9=Ebony |last10=Lee |first10=Kathryn |last11=Barak |first11=Narquis |last12=Brady |first12=Kathleen A. |last13=Braunstein |first13=Sarah |last14=Davis |first14=Jasmine |last15=Glick |first15=Sara |date=2024-01-25 |title=Prevalence of Discrimination and the Association Between Employment Discrimination and Health Care Access and Use—National HIV Behavioral Surveillance Among Transgender Women, Seven Urban Areas, United States, 2019, 2020 |journal=MMWR Supplements |volume=73 |issue=1 |pages=51–60 |doi=10.15585/mmwr.su7301a6 |issn=2380-8950 |pmc=10826684 |pmid=38261571 |doi-access=free}}</ref> Programs that fail to address the specific needs of transgender women often categorize them as cisgender men, resulting in a lack of culturally competent care.<ref>{{Citation |last1=Bass |first1=Brittany |title=Cultural Competence in the Care of LGBTQ Patients |date=2025 |work=StatPearls |url=https://www.ncbi.nlm.nih.gov/books/NBK563176/ |access-date=2025-03-01 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=33085323 |last2=Nagy |first2=Hassan}}</ref> Culturally competent care involves delivering healthcare services that acknowledge and respect the diverse cultural backgrounds, values, and needs of patients. In the context of HIV/AIDS, this approach is vital for addressing health disparities among marginalized groups. For instance, a 2024 study by the Kirby Institute reported a 21.5% increase in HIV notifications among individuals from culturally and linguistically diverse (CALD) backgrounds in Australia over the past decade.<ref>{{Cite web |title=Improving our understanding of HIV notifications among people from Culturally and Linguistically Diverse backgrounds in Australia |url=https://www.healthequitymatters.org.au/resources/improving-our-understanding-of-hiv-notifications-among-people-from-culturally-and-linguistically-diverse-backgrounds-in-australia |access-date=2025-04-03 |website=Health Equity Matters |language=en}}</ref>

=== Access to PrEP among marginalized groups === Marginalized groups also face barriers to accessing HIV/AIDS preventative care such as PrEP. Studies have shown that concerns about paying for PrEP and talking to healthcare providers about sexual behaviors have contributed to low PrEP use among young sexual minority men.<ref>{{cite journal | vauthors = Jaiswal J, Griffin M, Singer SN, Greene RE, Acosta IL, Kaudeyr SK, Kapadia F, Halkitis PN | display-authors = 6 | title = Structural Barriers to Pre-exposure Prophylaxis Use Among Young Sexual Minority Men: The P18 Cohort Study | journal = Current HIV Research | year = 2018 | volume = 16 | issue = 3 | pages = 237–249 | pmid = 30062970 | doi = 10.2174/1570162x16666180730144455 | pmc = 8893045 | s2cid = 51876690 }}</ref> Other structural barriers to PrEP use include limited knowledge of its availability, stigma surrounding HIV, and distrust of the medical establishment among minority groups due to years of discrimination within the medical field against marginalized groups.<ref>{{cite journal | vauthors = Mayer KH, Agwu A, Malebranche D | title = Barriers to the Wider Use of Pre-exposure Prophylaxis in the United States: A Narrative Review | journal = Advances in Therapy | volume = 37 | issue = 5 | pages = 1778–1811 | date = May 2020 | pmid = 32232664 | pmc = 7467490 | doi = 10.1007/s12325-020-01295-0 }}</ref> A poll conducted on the gay dating-app Grindr found a high prevalence of poor access to health insurance and lack of education about PrEP among respondents.<ref>{{Cite web|title=Three Potential Barriers to HIV PrEP|url=https://www.pharmacytimes.com/view/three-potential-barriers-to-hiv-prep|access-date=2021-04-07|website=Pharmacy Times|date=15 January 2016 }}</ref> Among transgender women, studies have found that cost concerns, mental health, substance use issues, concerns about hormone interaction, uncomfortable side effects, difficulty taking pills, stigma, exclusion of transgender women in advertising, and lack of research on transgender women and PrEP are all barriers to PrEP. In addition, structural barriers to PrEP use among transgender women include employment, transportation, and housing insecurity/homelessness.<ref>{{cite journal | vauthors = Ogunbajo A, Storholm ED, Ober AJ, Bogart LM, Reback CJ, Flynn R, Lyman P, Morris S | display-authors = 6 | title = Multilevel Barriers to HIV PrEP Uptake and Adherence Among Black and Hispanic/Latinx Transgender Women in Southern California | journal = AIDS and Behavior | date = January 2021 | volume = 25 | issue = 7 | pages = 2301–2315 | pmid = 33515132 | pmc = 7845787 | doi = 10.1007/s10461-021-03159-2|issn=1090-7165 }}</ref><ref>{{cite journal | vauthors = Rael CT, Martinez M, Giguere R, Bockting W, MacCrate C, Mellman W, Valente P, Greene GJ, Sherman S, Footer KH, D'Aquila RT, Carballo-Diéguez A | display-authors = 6 | title = Barriers and Facilitators to Oral PrEP Use Among Transgender Women in New York City | journal = AIDS and Behavior | volume = 22 | issue = 11 | pages = 3627–3636 | date = November 2018 | pmid = 29589137 | pmc = 6160363 | doi = 10.1007/s10461-018-2102-9 }}</ref> A study of Black MSM in London found that instances of racism in spaces dedicated to gay men led to an avoidance of these spaces among the study participants, leading Black MSM to miss out on PrEP awareness that was disseminated via gay channels.<ref>{{Cite web|title=Racism, marginalisation and PrEP stereotypes affect PrEP uptake for black MSM in London|url=https://www.aidsmap.com/news/apr-2019/racism-marginalisation-and-prep-stereotypes-affect-prep-uptake-black-msm-london|access-date=2021-04-07|website=aidsmap.com|date=9 April 2019 |language=en}}</ref>

=== HIV/AIDS disparities among the incarcerated population === As of the end of 2018, the black imprisonment rate was about twice that of Hispanics and more than five times the imprisonment rate amongst whites in the United States.<ref name=":32">{{Cite web|title=Black imprisonment rate in the U.S. has fallen by a third since 2006|url=https://www.pewresearch.org/fact-tank/2020/05/06/share-of-black-white-hispanic-americans-in-prison-2018-vs-2006/|access-date=2021-04-26|website=Pew Research Center|date=6 May 2020 |language=en-US}}</ref> Moreover, black males are more likely to be imprisoned with 2,272 inmates per 100,000 black men, in comparison to 1,018 inmates per 100,000 Hispanic men and 392 inmates per 100,000 white men.<ref name=":32" /> Incarcerated individuals have a much higher risk of having HIV than non-incarcerated individuals. The estimated global HIV prevalence for prisoners is 3%, whereas the estimated global HIV prevalence for adults in general is 0.7%.<ref name="Transgender people">{{Cite web|title=Transgender people|url=https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/maternal-health/about/global-hiv-hepatitis-and-stis-programme|access-date=2021-04-08|website=www.who.int|language=en}}</ref><ref>{{Cite web|date=2021-03-02|title=The Global HIV/AIDS Epidemic|url=https://www.kff.org/global-health-policy/fact-sheet/the-global-hivaids-epidemic/|access-date=2021-04-08|website=KFF|language=en-US|archive-date=2021-04-11|archive-url=https://web.archive.org/web/20210411124444/https://www.kff.org/global-health-policy/fact-sheet/the-global-hivaids-epidemic/|url-status=dead}}</ref> Additionally, women in prison have a higher HIV prevalence than men.<ref name="Transgender people"/> Incarcerated individuals also have a high risk of transmission as well due to high-risk activity (i.e. unsafe and unsterile tattooing, needle sharing, and unprotected sexual activity). Needle sharing is much more prevalent in prisons because possession of needles in prison is oftentimes a criminal offense, causing clean needles to be scarce.<ref>{{Cite web|date=2015-07-20|title=Prisoners, HIV and AIDS|url=https://www.avert.org/professionals/hiv-social-issues/key-affected-populations/prisoners|access-date=2021-04-08|website=Avert|language=en}}</ref> Only about 30% of countries worldwide offer condoms for incarcerated individuals, but for the countries that do offer condoms, coverage and access is not reported.<ref>{{cite journal|last1=Moazen|first1=Babak|date=January 2019|title=Availability, coverage and barriers towards condom provision in prisons: a review of the evidence|url=https://media.tghn.org/medialibrary/2019/01/FINAL_Condoms_in_Prisons__21.11.2018.pdf|journal=Frankfurt am Main/Germany: Institut für Suchtforschung (ISFF), Frankfurt University of Applied Sciences}}</ref> Moreover, these individuals have a harder time accessing critical HIV resources such as ART.<ref>{{cite journal|publisher=UNAIDS|title=Prisoners|url=https://www.unaids.org/sites/default/files/media_asset/03_Prisoners.pdf|journal=The Gap Report 2014}}</ref> Even if ART is offered, those with HIV may still lack the ability to get specialized care and specific ART regimens.<ref>{{cite journal|last1=Rich|first1=Josiah D|last2=Beckwith|first2=Curt G|last3=Macmadu|first3=Alexandria|last4=Marshall|first4=Brandon D L|last5=Brinkley-Rubinstein|first5=Lauren|last6=Amon|first6=Joseph J|last7=Milloy|first7=M-J|last8=King|first8=Maximilian R F|last9=Sanchez|first9=Jorge|last10=Atwoli|first10=Lukoye|last11=Altice|first11=Frederick L|date=10 September 2016|title=Clinical care of incarcerated people with HIV, viral hepatitis, or tuberculosis|url= |journal=The Lancet|language=en|volume=388|issue=10049|pages=1103–1114|doi=10.1016/S0140-6736(16)30379-8|pmid=27427452|pmc=5504684|issn=0140-6736}}</ref>

=== HIV/AIDS disparities among undocumented immigrants === Immigrants are a significant population that does not test themselves for HIV/AIDS or even get treated for this illness.<ref>{{Cite journal |last1=Ojikutu |first1=Bisola O. |last2=Mazzola |first2=Emanuele |last3=Fullem |first3=Andrew |last4=Vega |first4=Rodolfo |last5=Landers |first5=Stewart |last6=Gelman |first6=Rebecca S. |last7=Bogart |first7=Laura M. |date=July 2016 |title=HIV Testing Among Black and Hispanic Immigrants in the United States |journal=AIDS Patient Care and STDs |language=en |volume=30 |issue=7 |pages=307–314 |doi=10.1089/apc.2016.0120 |pmid=27410494 |pmc=4948212 |issn=1087-2914}}</ref> More specifically, undocumented immigrants are one of the leading immigrant populations that do not get tested or treated, and they make up a majority of uninsured people and lack access to healthcare.<ref>{{Cite web |last1=Pillai |first1=Akash |last2=Pillai |first2=Drishti |last3=Published |first3=Samantha Artiga |date=2024-05-01 |title=State Health Coverage for Immigrants and Implications for Health Coverage and Care |url=https://www.kff.org/racial-equity-and-health-policy/issue-brief/state-health-coverage-for-immigrants-and-implications-for-health-coverage-and-care/ |access-date=2024-05-07 |website=KFF |language=en-US}}</ref> Language is one major barrier for immigrants, since many who are immigrants do not speak English as their first language, and the lack of language-inclusive information when it comes to ART or PrEP treatment decreases an immigrant's chance of getting the correct type of care necessary for HIV/AIDS.<ref name=":9">{{Cite journal |last1=Dang |first1=Bich N. |last2=Giordano |first2=Thomas P. |last3=Kim |first3=Jennifer H. |date=February 2012 |title=Sociocultural and Structural Barriers to Care Among Undocumented Latino Immigrants with HIV Infection |url=http://link.springer.com/10.1007/s10903-011-9542-x |journal=Journal of Immigrant and Minority Health |language=en |volume=14 |issue=1 |pages=124–131 |doi=10.1007/s10903-011-9542-x |pmid=22012476 |issn=1557-1912|url-access=subscription }}</ref> This barrier is especially true for undocumented Hispanic/Latino immigrants, where Spanish is their primary first language, and one interview-based study found that undocumented Hispanic/Latinos have a more challenging time finding someone who can explain to them information about HIV testing and treatment in their native language.<ref name=":9" />

In addition, misconceptions of healthcare options for undocumented immigrants still exist, and this affects their chances of getting HIV testing. A study conducted in the New York metropolitan area found that undocumented immigrants who live with HIV/AIDS or are at risk refuse to visit a hospital or seek a medical provider to attend to their medical needs due to them not wanting to reveal their documentation status and not wanting to be deported.<ref name=":10">{{Cite journal |last1=Shedlin |first1=Michele G. |last2=Drucker |first2=Ernest |last3=Decena |first3=Carlos U. |last4=Hoffman |first4=Susie |last5=Bhattacharya |first5=Gauri |last6=Beckford |first6=Sharlene |last7=Barreras |first7=Ricardo |date=2006-03-23 |title=Immigration and HIV/AIDS in the New York Metropolitan Area |journal=Journal of Urban Health |language=en |volume=83 |issue=1 |pages=43–58 |doi=10.1007/s11524-005-9006-5 |pmid=16736354 |pmc=2258326 |issn=1099-3460}}</ref> This fear is rooted in many undocumented people coming to the US for a better opportunity financially, educationally, and socially for themselves and their families, resulting in undocumented immigrants choosing not to risk and jeopardize their family or their future in the US to get tested or treated for HIV/AIDS.<ref name=":10" /> The belief of being deported for getting medical treatment is connected to misinformation spreading in the immigrant population, and many do not know that their immigration status does not turn them away from medical care, even more for HIV/AIDS treatment and testing.

=== Effects of COVID-19 Pandemic on people with HIV/AIDS === Inequities resulting from discrimination and stigma towards PLHIV can impact susceptibility to other public health threats. Discrimination in the housing, medical, and employment sectors towards PLHIV has helped to drive the COVID-19 public health threat in marginalized populations.<ref>{{Cite journal |last1=Winwood |first1=Jordan J. |last2=Fitzgerald |first2=Lisa |last3=Gardiner |first3=Bernard |last4=Hannan |first4=Kate |last5=Howard |first5=Chris |last6=Mutch |first6=Allyson |date=December 2021 |title=Exploring the Social Impacts of the COVID-19 Pandemic on People Living with HIV (PLHIV): A Scoping Review |journal=AIDS and Behavior |language=en |volume=25 |issue=12 |pages=4125–4140 |doi=10.1007/s10461-021-03300-1 |issn=1090-7165 |pmc=8137806 |pmid=34019203}}</ref> Many of the groups most vulnerable to HIV infection, such as people of color or individuals living in poverty, are also at increased risk of contracting COVID-19. PLHIV also appear to be more likely to live in the areas hit hardest by COVID-19. The Kaiser Family Foundation found that 15 of the 20 counties with the highest HIV prevalence in the US were also ranked in the top 20 counties with the highest COVID-19 morbidity and mortality rates.<ref name=":4">{{Cite web |date=2021-05-20 |title=Key Questions: HIV and COVID-19 |url=https://www.kff.org/coronavirus-covid-19/issue-brief/key-questions-hiv-and-covid-19/ |access-date=2022-05-14 |website=KFF |language=en-US}}</ref>

The effects of COVID-19 on people with HIV is still being studied. It is thought individuals of older age or with serious underlying medical conditions may be at greater risk for severe illness from COVID-19. This includes people with HIV who have comorbidities, a low CD4 cell count, or are not currently on effective HIV treatment.<ref name=":03">{{Cite web|date=2020-02-11|title=COVID-19 and Your Health|url=https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/hiv.html|access-date=2021-03-03|publisher=Centers for Disease Control and Prevention|language=en-us}}</ref> The Coronavirus Under Research Exclusion (CURE HIV-COVID) database collects information on outcome of COVID-19 in people living with HIV.<ref>{{Cite web|title=HIV-COVID|url=https://hivcovid.org/|access-date=2021-04-08|website=HIV-COVID Database|archive-date=2021-04-17|archive-url=https://web.archive.org/web/20210417083627/https://hivcovid.org/|url-status=dead}}</ref> According to the WHO, 23.1% of PLHIV hospitalized for COVID-19 died from the disease, making HIV a risk-factor for severe illness or death due to the virus.<ref name=":5">{{Cite web |title=Coronavirus disease (COVID-19): COVID-19 vaccines and people living with HIV |url=https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-covid-19-vaccines-and-people-living-with-hiv |access-date=2022-05-14 |website=www.who.int |language=en}}</ref> The CDC, WHO, and other health organizations have recommended that PLHIV are given priority for COVID-19 vaccination, and the CDC has recommended additional vaccine doses for PLHIV with advanced disease or who are not taking medication to treat their HIV.<ref name=":5" /><ref>{{Cite journal |last=Dooling |first=Kathleen |date=2020 |title=The Advisory Committee on Immunization Practices' Interim Recommendation for Allocating Initial Supplies of COVID-19 Vaccine — United States, 2020 |url=https://www.cdc.gov/mmwr/volumes/69/wr/mm6949e1.htm |journal=MMWR. Morbidity and Mortality Weekly Report |language=en-us |volume=69 |issue=49 |pages=1857–1859 |doi=10.15585/mmwr.mm6949e1 |pmid=33301429 |pmc=7737687 |issn=0149-2195}}</ref> Some states have explicitly prioritized vaccination for people living with HIV, while others used the broader criteria of individual who are in an "immunocompromised state", which can include PLHIV. <ref name=":4" />

At various points in the pandemic, hospitals were overwhelmed by the number of COVID-19 patients, some of whom required intensive treatments like invasive ventilation and extracorporeal membrane oxygenation (ECMO).<ref>{{Cite news |last=Fink |first=Sheri |date=2021-07-12 |title=The Rationing of a Last-Resort Covid Treatment |language=en-US |work=The New York Times |url=https://www.nytimes.com/2021/07/12/us/covid-treatment-ecmo.html |access-date=2022-05-14 |issn=0362-4331}}</ref><ref>{{Cite news |last1=Nagourney |first1=Eric |last2=Delkic |first2=Melina |last3=Rio |first3=Giulia McDonnell Nieto del |last4=Bogel-Burroughs |first4=Nicholas |date=2020-10-26 |title=A surge in hospitalizations is straining some U.S. health care facilities. |language=en-US |work=The New York Times |url=https://www.nytimes.com/2020/10/26/us/a-surge-in-hospitalizations-is-straining-some-us-health-care-facilities.html |access-date=2022-05-14 |issn=0362-4331}}</ref> As a result, there were serious concerns about the need to institute care rationing systems which would provide criteria for the prioritization of patients to receive medical attention and treatment. As there was little coordination between hospitals or guidance from local and state governments, many immunocompromised individuals, including PLHIV, were uncertain of the implications of these policies on their access to care. In March 2020, the Office for Civil Rights in the Department of Health and Human Services filed a complaint against Washington and Alabama for their care rationing policies, citing them as discriminatory against individuals with disabilities.<ref>{{Cite news |last=Fink |first=Sheri |date=2020-03-28 |title=U.S. Civil Rights Office Rejects Rationing Medical Care Based on Disability, Age |language=en-US |work=The New York Times |url=https://www.nytimes.com/2020/03/28/us/coronavirus-disabilities-rationing-ventilators-triage.html |access-date=2022-05-14 |issn=0362-4331}}</ref><ref>Arno, Peter S. “Federal Failures in the AIDS epidemic.” The New York Times August 21, 1985.</ref>

== Global perspective == While the existing discourse on HIV/AIDS-related discrimination largely focuses on the US, it is a worldwide issue. Countries such as South Africa, India, and Russia experience high levels of stigma and discrimination, often exacerbated by government policies or social attitudes. Recent global data indicate that approximately 39 million people are living with HIV/AIDS, with sub-Saharan Africa bearing the highest burden.<ref>{{Cite journal |last1=Moyo |first1=Enos |last2=Moyo |first2=Perseverance |last3=Murewanhema |first3=Grant |last4=Mhango |first4=Malizgani |last5=Chitungo |first5=Itai |last6=Dzinamarira |first6=Tafadzwa |date=2023-05-16 |title=Key populations and Sub-Saharan Africa's HIV response |journal=Frontiers in Public Health |volume=11 |article-number=1079990 |doi=10.3389/fpubh.2023.1079990 |doi-access=free |pmid=37261232 |pmc=10229049 |bibcode=2023FrPH...1179990M |issn=2296-2565}}</ref> In China, PLHIV have faced employment discrimination, while in Eastern Europe, HIV/AIDS stigma is often linked to drug use and marginalized communities.<ref>{{Cite journal |last1=Mo |first1=Phoenix K. H. |last2=Ng |first2=Charlson T. Y. |date=2017 |title=Stigmatization among people living with HIV in Hong Kong: A qualitative study |journal=Health Expectations |language=en |volume=20 |issue=5 |pages=943–951 |doi=10.1111/hex.12535 |issn=1369-7625 |pmc=5600241 |pmid=28195685}}</ref><ref>{{Cite journal |last1=Hook |first1=Kimberly |last2=Sereda |first2=Yuliia |last3=Rossi |first3=Sarah |last4=Koberna |first4=Sarah |last5=Vetrova |first5=Marina V. |last6=Lodi |first6=Sara |last7=Lunze |first7=Karsten |date=2023 |title=HIV, substance use, and intersectional stigma: Associations with mental health among persons living with HIV who inject drugs in Russia |journal=AIDS and Behavior |language=en |volume=27 |issue=2 |pages=431–442 |doi=10.1007/s10461-022-03778-3 |issn=1090-7165 |pmc=9889571 |pmid=35913589}}</ref> Many countries have laws that criminalize HIV transmission, exposure, or nondisclosure. These laws, found in parts of the US, Canada, and sub-Saharan Africa, often disproportionately impact marginalized communities and deter individuals from getting tested or seeking treatment due to fear of legal consequences.<ref name=":11">{{Cite journal |last1=Lazzarini |first1=Zita |last2=Galletly |first2=Carol L. |last3=Mykhalovskiy |first3=Eric |last4=Harsono |first4=Dini |last5=O’Keefe |first5=Elaine |last6=Singer |first6=Merrill |last7=Levine |first7=Robert J. |date=2013 |title=Criminalization of HIV Transmission and Exposure: Research and Policy Agenda |journal=American Journal of Public Health |language=en |volume=103 |issue=8 |pages=1350–1353 |doi=10.2105/AJPH.2013.301267 |pmid=23763428 |pmc=3966663 |issn=0090-0036}}</ref> Human rights organizations argue that such laws fuel stigma and do not align with modern public health strategies.

However, global perspectives do address advocacy as well. Many countries have enacted anti-discrimination laws to protect PLHIV. The ADA in the US provides legal recourse against discrimination based on HIV status.<ref>{{Cite web |title=Protecting the Rights of Persons Living with HIV/AIDS |url=https://archive.ada.gov/hiv/ada_hiv_brochure.html |access-date=2025-02-28 |website=archive.ada.gov}}</ref> India's 2017 HIV/AIDS (Prevention and Control) Act additionally bans discrimination in employment, education, and healthcare.<ref>{{Cite web |title=HIV/AIDS (Prevention & Control), Act 2017 – PACS |url=https://pondicherrysacs.in/hiv-aids-prevention-control-act-2017/ |archive-url=https://web.archive.org/web/20240911155904/https://pondicherrysacs.in/hiv-aids-prevention-control-act-2017/ |archive-date=2024-09-11 |access-date=2025-02-28 |website=pondicherrysacs.in |language=en |url-status=live }}</ref> The Indian Health Service created the Trans & Gender-Affirming Care in I/T/U Facilities Strategic Vision and Action Plan, which promotes an intersectional approach in research and services for patients with HIV.<ref>{{Cite journal |last=Gaist |first=Paul A. |last2=Greenwood |first2=Gregory L. |last3=Wilson |first3=Amber |last4=Dempsey |first4=Antigone |last5=Harrison |first5=Timothy P. |last6=Haverkate |first6=Richard T. |last7=Koenig |first7=Linda J. |last8=McCree |first8=Donna Hubbard |last9=Palmieri |first9=John |last10=Phillips |first10=Harold J. |date=June 2022 |title=US Government Health Agencies’ Efforts to Address HIV-Related Intersectional Stigma |url=https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2022.306732 |journal=American Journal of Public Health |volume=112 |issue=S4 |pages=S401–S404 |doi=10.2105/AJPH.2022.306732 |issn=0090-0036|pmc=9241466 }}</ref> The Global Commission on HIV and the Law advocates for removing punitive laws that criminalize HIV exposure and transmission, which contribute to further stigmatization.<ref name=":11" /> Attitudes also differ based on religiosity in certain regions. Some groups, particularly in conservative communities, have perpetuated stigma by linking HIV/AIDS to "moral failings".<ref>{{Cite journal |last1=Mahamboro |first1=Dionius B. |last2=Fauk |first2=Nelsensius K. |last3=Ward |first3=Paul R. |last4=Merry |first4=Maria S. |last5=Siri |first5=Theodorus A. |last6=Mwanri |first6=Lillian |date=2020-01-19 |title=HIV Stigma and Moral Judgement: Qualitative Exploration of the Experiences of HIV Stigma and Discrimination among Married Men Living with HIV in Yogyakarta |journal=International Journal of Environmental Research and Public Health |language=en |volume=17 |issue=2 |page=636 |doi=10.3390/ijerph17020636 |doi-access=free |pmid=31963807 |issn=1660-4601|pmc=7013688 }}</ref> On the contrast, many faith-based organizations, such as Catholic Relief Services and the Islamic Medical Association of Uganda, have provided critical support in HIV prevention, treatment, and education.<ref>{{Cite journal |last1=Kagimu |first1=M |last2=Guwatudde |first2=D |last3=Rwabukwali |first3=C |last4=Kaye |first4=S |last5=Walakira |first5=Y |last6=Ainomugisha |first6=D |date=2012 |title=Religiosity for HIV prevention in Uganda: a case study among Muslim youth in Wakiso district |journal=African Health Sciences |volume=12 |issue=3 |pages=282–290 |doi=10.4314/ahs.v12i2.7 |issn=1680-6905 |pmc=3557679 |pmid=23382741}}</ref>

In recent years, changes in US foreign policy have significantly affected international HIV/AIDS relief efforts. Funding cuts to the President's Emergency Plan for AIDS Relief (PEPFAR) during the Trump administration placed millions of people at risk, particularly LGBTQ+ communities in Africa.<ref>{{Cite web |date=2025-04-08 |title=US cuts to HIV programs in Africa threaten to set progress back to 'dark ages,' experts say {{!}} CIDRAP |url=https://www.cidrap.umn.edu/hivaids/us-cuts-hiv-programs-africa-threaten-set-progress-back-dark-ages-experts-say#:~:text=The%20reduction%20or%20elimination%20of,published%20today%20in%20The%20Lancet. |access-date=2025-04-11 |website=www.cidrap.umn.edu |language=en}}</ref> According to projections published in ''The Lancet'', without the continued support of PEPFAR, Africa could see one million additional child infections and half a million child deaths from HIV/AIDS by 2030.<ref>{{Cite journal |last1=Cluver |first1=Lucie |last2=Makangila |first2=Gibstar |last3=Hillis |first3=Susan |last4=Ntwali-N'Konzi |first4=Joel-Pascal |last5=Flaxman |first5=Seth |last6=Unwin |first6=Juliette |last7=Imai-Eaton |first7=Jeffrey W |last8=Chtimbire |first8=Vuyelwa |last9=Sherr |first9=Lorraine |last10=Ng'ang'a |first10=Jane |last11=Desmond |first11=Chris |last12=Toska |first12=Elona |last13=Omigbodun |first13=Olayinka |last14=Ratmann |first14=Oliver |last15=Carey |first15=Galen |date=April 2025 |title=Protecting Africa's children from extreme risk: a runway of sustainability for PEPFAR programmes |url=https://doi.org/10.1016/s0140-6736(25)00401-5 |journal=The Lancet |volume=405 |issue=10490 |pages=1700–1712 |doi=10.1016/s0140-6736(25)00401-5 |pmid=40215987 |issn=0140-6736|url-access=subscription |hdl=1983/c9c2b928-b194-4275-904c-3dd562cc77d4 |hdl-access=free }}</ref> These policy shifts underscore how domestic political decisions in high-income countries can have global consequences for marginalized populations living with HIV. == See also == * Criminalization of HIV transmission * HIV exceptionalism * Undetectable = Untransmittable * HIV exceptionalism == References == {{reflist}}

{{HIV/AIDS}} {{LGBTQ}} {{Discrimination}}

HIV Category:HIV/AIDS