One of the most enduring lessons for me as a provider working in HIV care is that the stigma of HIV is oftentimes much more of a burden on people than the actual condition. HIV is one of the only conditions that tends to provoke a collective knee jerk response to judge and condemn. Education campaigns and glossy commercials of people seemingly living their best lives while HIV positive don’t begin to explicate the reality of HIV stigma in our society. It may or may not be an intended consequence that prevention efforts have often simultaneously served to make HIV-positive people social and moral pariahs in our society. This hampers the treatment work of medical professionals and disempowers people living with HIV from feeling comfortable living in their truths and taking care of all aspects of their health— physical, mental, emotional and spiritual. 

It is not enough for people to just take their medicine and go to necessary appointments. This does not mean someone should make HIV their entire life, but it does callfor deeper interrogation of one’s self. What does it mean to be positive to you?

Stigma serves a purpose. It is to remove the humanity of a person. Stigma is what speaks about you before you open your mouth. It is the barometer others use to choose how they will treat you. Stigma is the muck formed by others and attached to your name before you even introduce yourself.  Throughout history, stigma has been a facet of societies around the world. Those afflicted have often suffered in collective silence, managing their oppression and forming communities that resist the indictment of stigma by the greater society. 

Unfortunately, HIV stigma –coupled with high rates of trauma, mental illness and different identities within difficult socioeconomic contexts — makes community building around HIV that much more challenging. The result is a community that not only tends to suffer in silence,  but whose silence is reinforced by a wide array of propaganda by mainstream society, making HIV stigma not only omnipresent but institutionally sanctioned.

HIV-positive people are much more than their diagnosis. As a worker in this field for almost a decade, I am continually struck by how brave and persevering people living with HIV are. I have seen people with the highest viral loads and disbelief in their status become perfect attendees at appointments, with undetectable viral loads.. I have had patients who navigated homelessness, sexual assault survivors, substance users, single parents, business owners, and public assistance recipients become the most outspoken advocates for adherence and wellness across many areas of their lives. 

And yet the stigma remains. There are still people in 2025 who believe one can contract HIV through casual contact. There are people who still believe HIV is the punishment for people who live immoral lives. There are still people who believe HIV is a death sentence. 

This is why I believe everyone who works in this field needs to consider stigma and the weight it holds in the lives of our patients. We need to think about more than our patients taking pills;we need to ask them how they feel about taking those pills. We need to think about why some patients won’t go to other clinics. We need to understand their possible fear of being discriminated against because of their status. We need to interrogate why some patients decide to never take their medicine. We need to consider that they possibly don’t see their lives as ones worth living. 

HIV stigma will not change overnight. It could even be said that the stigma is not as bad as it was in the 1980’s, 90’s or early 2000’s, but make no mistake:  HIV stigma is alive and well across racial, ethnic, religious and any other demarcation of society. Someone can disclose that they are living with cancer, diabetes or lupus and receive widespread support and compassion.  But the conversation about HIV and people living with it, are often doused with shame and neglect by a society that paints itself as blameless and paragons of morality.

Stigma and shame kill people. In more ways than one. The price on society is infinite. Deeming one group worthy of compassion while another is condemned will always smack in the face of all who have given their lives hoping for better. As healthcare professionals, our responsibility to those we serve  is bigger than lab results. We want empowered, resilient, educated people who promote messages of wellness and take ownership of their narratives and realities. 

Make it a habit to ask not only what you are doing, but how you are doing. It matters more than we know. 

Shante Austin