Discrimination against HIV-Infected People and the Spread of HIV: Some Evidence from France

Abstract

BackgroundMany people living with HIV/AIDS (PLWHA) suffer from stigma and discrimination. There is an ongoing debate, however, about whether stigma, fear and discrimination actually fuel the persisting spread of HIV, or slow it down by reducing contacts between the whole population and high-risk minorities. To contribute to this debate, we analysed the relationship between perceived discrimination and unsafe sex in a large sample of French PLWHAs.Methodology/Principal FindingsIn 2003, we conducted a national cross-sectional survey among a random sample of HIV-infected patients. The analysis was restricted to sexually active respondents (N = 2,136). Unsafe sex was defined as sexual intercourse without a condom with a seronegative/unknown serostatus partner during the prior 12 months. Separate analyses were performed for each transmission group (injecting drug use (IDU), homosexual contact, heterosexual contact). Overall, 24% of respondents reported experiences of discrimination in their close social environment (relatives, friends and colleagues) and 18% reported unsafe sex during the previous 12 months. Both prevalences were higher in the IDU group (32% for perceived discrimination, 23% for unsafe sex). In multivariate analyses, experience of discrimination in the close social environment was associated with an increase in unsafe sex for both PLWHAs infected through IDU and heterosexual contact (OR = 1.65 and 1.80 respectively).ConclusionsOur study clearly confirms a relationship between discrimination and unsafe sex among PLWHAs infected through either IDU or heterosexual contact. This relationship was especially strong in the heterosexual group that has become the main vector of HIV transmission in France, and who is the more likely of sexual mixing with the general population. These results seriously question the hypothesis that HIV-stigma has no effect or could even reduce the infection spread of HIV.

Individual, Social, and Environmental Influences Associated With HIV Infection Among Injection Drug Users in Tijuana, Mexico

“…64 Although social stigma and/or discrimination may be risk factors for HIV infection, these relations have been understudied among IDUs and warrant further investigation. 23,61,65 We also identified risk factors for HIV infection that have been previously reported in other settings. The odds of HIV infection were nearly 3-fold higher among female IDUs, although they represented only 13% of the cohort.…”

HIV-Related Discrimination Reported by People Living with HIV in London, UK

“…Our analysis was based on selfreported data which rely, at least in part, on a respondent interpreting a negative experience as being HIV-related discrimination. This is an inherent limitation of all research into discrimination, since it relies not only on subjective experience but also on a person's willingness to report the experience (Rothon & Heath, 2003;Harris et al, 2006;Huebner et al, 2004;Krieger, 2000;Peretti-Watel et al, 2007). For example, we can not rule out the possibility that the concept (and reporting) of discrimination varies between cultures, specifically between gay men (predominantly white in our study) and heterosexual men and women of black African origin.…”

“…This is a problem faced by other researchers too. For example, a recent French study asked people with HIV whether they had ever felt discriminated against by relatives, friends or colleagues because of their serostatus (Peretti-Watel et al, 2007). Respondents included gay men, intravenous drug users and black African heterosexual men and women all of whom may be stigmatised regardless of their HIV status.…”

“…There is also evidence that HIV discrimination may contribute to an increase in HIV risk behaviours. (Kinniburgh, Scott, Gottleib, & Power, 2001;Atrill, Kinniburgh, & Power, 2001;Berger, Ferrans CE, & Lashley FR, 2001;Carr & Gramling, 2004;Fife BL & Wright ER, 2000;Green & Sobo, 2000;Petrak, Doyle, Smith, Skinner, & Hedge, 2001;McMunn, Mwanje, & Posniak, 1997;Erwin & Peters, 1999;Dodds et al, 2004;Carter, 2006;Chesney & Smith, 1999;Kalichman & Simbayi, 2003;Stall et al, 1996;Herek, Capitanio, & Widaman, 2003;Peretti-Watel, Spire, Obadia, & Moatti, 2007). From a theoretical perspective, discussion of HIV-related discrimination has traditionally drawn on Goffman's seminal work on stigma and spoiled identity (Goffman, 1963).…”

Stigma and Discrimination against People Living with HIV in Juba, South Sudan

“…Despite the progress in understanding of HIV/AIDS, managing stigma and discrimination continued to be a serious issue in Juba, South Sudan the consequences of discrimination against PLHIV results in poor quality of care and services for those who are infected or ill or suspected of being infected [8,9], frightened away potential clients in need of care by limiting individual access to use of healthcare services such as Voluntary Counselling and Testing and early enrolment for Antiretroviral drugs. The access and use of these lifesaving services will depend on the degree to which health facilitator's welcome and respect the rights of HIV/ AIDS clients [10][11][12].…”