Combatting Stigma with Science: Opening pathways to treatment

For many Canadians, reaching out to a medical professional, like a family doctor, simply takes a phone call or a drive to the clinic. Yet for some, stigma and discrimination are barriers to essential medical testing or treatment.

Stigma begins with the labelling of differences and negative stereotyping of people, creating a separation between “us” and “them.” It can lead to disadvantages and inequitable social and health outcomes.

The Public Health Agency of Canada (PHAC) is working to reduce stigma and discrimination associated with sexually transmitted and blood borne infections (STBBI) like Human Immunodeficiency Virus (HIV), so that everyone can feel confident accessing healthcare. Fear of being stigmatized can prevent people from getting tested for STBBI and knowing their HIV status, which is key to starting life-saving treatments.

Science stops stigma

PHAC’s National Microbiology Laboratory (NML) scientists oversee training, capacity building, development and validation of innovative diagnostic tests for STBBI. They also offer quality assurance support to HIV diagnostic laboratories around the globe.

Dr. Adrienne Meyers, an HIV Research Scientist at the NML, has been working with global partners to eliminate HIV/AIDS as a public health threat for 14 years.

“It is important to acknowledge that everyone has unique needs, so we try to be sensitive to each community by working with them to find the most appropriate options,” says Dr. Meyers. “A large part of our work is centred on listening and understanding how accessing conventional methods of testing is challenging for many individuals. Innovative approaches are needed to reach the undiagnosed and to help eliminate barriers and reduce stigma associated with STBBI testing. Collaboration is important, and it all begins with a dialogue. The best way to reduce stigma is to start a conversation and dispel misinformation.”

Dr. Meyers’ team supports over 1,500 participating sites worldwide to ensure that HIV test results are both immediate and accurate, which is especially important in countries where supportive infrastructure is unavailable.

“We constantly run community readiness assessments to see where our partnering sites are with their diagnostic capabilities,” says Dr. Meyers. “If we find that a lab is not performing to appropriate standards, we will provide feedback and investigate the cause of inaccuracy. This will increase the lab’s diagnostic capabilities and empower communities with the skills they need to stay protected from illness.”

Another way PHAC scientists are working to reduce stigma is by bundling lab tests so that people can be tested for many STBBI at the same time — instead of needing to inquire about each one individually in specialized clinics. The goal is to make STBBI testing part of routine medical care, rather than requesting specialized tests that can be isolating and hard to access.

Facts over fiction: why testing matters

One driver behind HIV related stigma is the fear of infection. Misinformed people are more likely to stigmatize people who live with HIV. The truth is that HIV is difficult to contract when taking proper precautions, like using condoms to practice safe sex and not sharing needles. It is important to understand you will not get HIV through regular association with another person.

For people who live with HIV, like people living with other chronic illnesses such as diabetes or heart disease, stigma and discrimination make it more difficult for them to access treatment and support. Understanding the science behind the cause of infection and helping to educate people on the actual medical facts is a powerful tool to eradicate stigma.

For instance, people living with HIV on treatment regularly have their “viral load” tested – a measurement of how much virus is in the blood. Scientific research and evidence say that someone on treatment whose HIV is undetectable has effectively no risk of transmitting HIV to another person sexually. This does not mean that the HIV is gone or cured, rather treatment supresses HIV from copying itself in the blood. Regular viral load tests are therefore part of the management of the chronic illness and a way for people living with HIV to confirm their HIV is undetectable and untransmittable, or more commonly U=U.

This is all evidence that scientific understanding can help tackle stigma and discrimination. Science can also help knock down health inequities as well as the barriers to HIV prevention, testing and treatment.