Over the past few years, the rhetorical response to the HIV/AIDS pandemic has become progressively stronger. At the AIDS 2014 conference held in Melbourne in July, UNAIDS director Michel Sidibé announced the strategic goal of 'Ending HIV by 2030'. The overflowing plenary session heard bold new targets for testing and treatment, as well as stigma reduction. Global targets can be used to benchmark countries – but measuring a reduction in stigma is harder than it sounds.
At a subsequent session, the cavernous chamber was almost empty as a sparse crowd listened to an expert panel on 'evidence based stigma reduction'. As one of my colleagues asked, 'what's the international standard unit for one stigma?'
Dr Taweesap Siraprapasiri spoke that night about a systematic effort in Thailand to measure stigma towards people living with HIV. This involves developing panels of eight to twelve standard questions that can be dropped into nationwide telephone surveys or interviews with healthcare practitioners. They ask about attitudes like whether people with HIV should feel ashamed, and practices such as clinicians typically wearing double gloves when caring for people with HIV. Around half the participants (48 per cent) answered yes to both questions during pilot testing in Bangkok.
Are those questions adequate? In my writing about stigma I often describe it as a complex social process. The word 'complex' has an etymology that combines the senses of being folded – having multiple levels – and plaited – weaving different strands together. In stigma, dynamic processes from different levels are interwoven: stigma emerges from the interaction of individual emotions and moral judgments, personal interactions and group identification, cultural stereotypes promoted by media narratives, and political beliefs about social order and inequality.
An example can be found in new criminal laws recently passed in Uganda in response to moral panics about homosexual sex and deliberate HIV infection. In a country once considered at the forefront of the global HIV/AIDS response, these laws reflect new prejudices beaten up by American evangelical missionaries and the uptake of British-style tabloid print and television news coverage.
Research in different countries suggest that as antiviral treatments make it possible to live without visible signs of HIV infection, attitudes often harden against people with HIV. This paradox may explain the rash of new laws criminalising HIV transmission, drafted in such haste that some would apply to a mother whose baby was born with the virus – even though it is