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      The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas

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          Abstract

          Stigma is a well-documented barrier to health seeking behavior, engagement in care and adherence to treatment across a range of health conditions globally. In order to halt the stigmatization process and mitigate the harmful consequences of health-related stigma (i.e. stigma associated with health conditions), it is critical to have an explicit theoretical framework to guide intervention development, measurement, research, and policy. Existing stigma frameworks typically focus on one health condition in isolation and often concentrate on the psychological pathways occurring among individuals. This tendency has encouraged a siloed approach to research on health-related stigmas, focusing on individuals, impeding both comparisons across stigmatized conditions and research on innovations to reduce health-related stigma and improve health outcomes. We propose the Health Stigma and Discrimination Framework, which is a global, crosscutting framework based on theory, research, and practice, and demonstrate its application to a range of health conditions, including leprosy, epilepsy, mental health, cancer, HIV, and obesity/overweight. We also discuss how stigma related to race, gender, sexual orientation, class, and occupation intersects with health-related stigmas, and examine how the framework can be used to enhance research, programming, and policy efforts. Research and interventions inspired by a common framework will enable the field to identify similarities and differences in stigma processes across diseases and will amplify our collective ability to respond effectively and at-scale to a major driver of poor health outcomes globally.

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          Conceptualizing Stigma

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            Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward.

            Although stigma is considered a major barrier to effective responses to the HIV/AIDS epidemic, stigma reduction efforts are relegated to the bottom of AIDS programme priorities. The complexity of HIV/AIDS-related stigma is often cited as a primary reason for the limited response to this pervasive phenomenon. In this paper, we systematically review the scientific literature on HIV/AIDS-related stigma to document the current state of research, identify gaps in the available evidence and highlight promising strategies to address stigma. We focus on the following key challenges: defining, measuring and reducing HIV/AIDS-related stigma as well as assessing the impact of stigma on the effectiveness of HIV prevention and treatment programmes. Based on the literature, we conclude by offering a set of recommendations that may represent important next steps in a multifaceted response to stigma in the HIV/AIDS epidemic.
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              From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures.

              Recent analyses suggest that lack of clarity in the conceptualization and measurement of HIV stigma at an individual level is a significant barrier to HIV prevention and treatment efforts. In order to address this concern, we articulate a new framework designed to aid in clarifying the conceptualization and measurement of HIV stigma among individuals. The HIV Stigma Framework explores how the stigma of HIV elicits a series of stigma mechanisms, which in turn lead to deleterious outcomes for HIV uninfected and infected people. We then apply this framework to review measures developed to gauge the effect of HIV stigma since the beginning of the epidemic. Finally, we emphasize the utility of using three questions to guide future HIV stigma research: who is affected by, how are they affected by, and what are the outcomes of HIV stigma?
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                Author and article information

                Contributors
                alstangl@gmail.com
                earnshaw@udel.edu
                carmen.logie@utoronto.ca
                w.v.brakel@leprastichtung.nl
                lsimbayi@hsrc.ac.za
                ibarre@icrw.org
                john.dovidio@yale.edu
                Journal
                BMC Med
                BMC Med
                BMC Medicine
                BioMed Central (London )
                1741-7015
                15 February 2019
                15 February 2019
                2019
                : 17
                Affiliations
                [1 ]ISNI 0000 0004 0508 0388, GRID grid.419324.9, International Center for Research on Women, ; 1120 20th St. NW, Suite 500N, Washington, DC, 20036 USA
                [2 ]ISNI 0000 0001 0454 4791, GRID grid.33489.35, Department of Human Development and Family Sciences, , University of Delaware, ; Newark, DE USA
                [3 ]ISNI 0000 0004 0474 0188, GRID grid.417199.3, Factor-Inwentash Faculty of Social Work, , University of Toronto and Women’s College Research Institute, Women’s College Hospital, ; Toronto, Ontario Canada
                [4 ]ISNI 0000 0004 1795 6789, GRID grid.480865.7, Netherlands Leprosy Relief, ; Amsterdam, Netherlands
                [5 ]ISNI 0000 0004 1937 1151, GRID grid.7836.a, Human Sciences Research Council & Department of Psychiatry & Mental Health, University of Cape Town, ; Cape Town, South Africa
                [6 ]ISNI 0000000419368710, GRID grid.47100.32, Yale University, ; New Haven, CT USA
                Article
                1271
                10.1186/s12916-019-1271-3
                6376797
                30764826
                42267acf-fa33-47ac-ac34-a88478495e10
                © The Author(s). 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: Fogarty International Center of the National Institutes of Health
                Funded by: FundRef http://dx.doi.org/10.13039/100004439, William and Flora Hewlett Foundation;
                Award ID: 2016-4379
                Funded by: UKaid from the Department for International Development
                Funded by: National Institute on Drug Abuse (US)
                Award ID: K01DA042881
                Funded by: Ontario Ministry of Research and Innovation Early Researcher Award
                Funded by: Canadian Foundation for Innovation
                Categories
                Correspondence
                Custom metadata
                © The Author(s) 2019

                Medicine
                stigma,discrimination,health conditions,disease,multi-level,theoretical framework,conceptual model

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