Stigma
Why It Matters
HIV-related stigma is associated with poorer health outcomes for people living with HIV (PLWH) because it can create a barrier to staying in care, taking medications, and promoting health. Stigma can also interact with and exacerbate existing health inequities. Evidence shows that HIV-related stigma varies by gender, race and ethnicity, socioeconomic status, and sexual orientation.
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In addition, laws that criminalize aspects of having HIV have been shown to stigmatize PLWH and negatively impact their health and their participation in prevention and care services.
Where We Stand Today
The 2006 Consumer Needs Assessment first measured stigma in Iowans living with HIV. It found that while PLWH experienced similar levels of stigma, Black Iowans experienced more external stigma related to discrimination while white Iowans experienced more internalized stigma related to disclosure of their HIV status and fears of interpersonal rejection.
Measures of stigma have been repeated since 2006. In the 2019 Consumer Needs Assessment, female respondents reported experiencing more stigma than other respondents. They were less likely to share their status, worried more about discrimination, and were more likely to feel that telling someone they were living with HIV was risky. The 2019 CNA also found that Latinx/Hispanic respondents experienced less stigma compared to all respondents. However, Latinx/Hispanic respondents (81%) were more likely to work hard to keep their HIV status a secret compared to all respondents (66%).
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In 2014, advocates in Iowa were successful in working with legislators to modernize Iowa’s HIV criminalization statute (Iowa Code 709C). Under the modernized statute (Iowa Code 709D), people with HIV are required to protect partners from exposure to HIV but do not necessarily have to disclose their HIV status. This protects PLWH and their partners.
What We're Doing Now
ESCALATE Learning Collaborative
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Iowa is a participant in Ending Stigma through Collaboration and Living All to Empowerment (ESCALATE), a national learning collaborative focused on addressing stigma. The goal of this collaborative is to develop, implement, and refine stigma reduction initiatives to address HIV-related stigma in Iowa.
Marketing
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Robust marketing aimed at increasing awareness of HIV and reducing HIV-related stigma. These activities are being implemented in multiple media markets, using multiple modes, attempting to engage both providers and the general public with a special focus on prioritized populations.
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Advocacy
Advocates continue to monitor criminalization of people with HIV and to discuss ways to ensure that public health data are kept confidential and used only to promote the health of Iowans.
To stop HIV in Iowa by 2030, this focus area must:
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Improve community participation and engagement in Iowa’s HIV planning process
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Develop a coordinated stigma plan for the state that includes training, marketing, and monitoring our progress.
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Reduce the number of people living with HIV (PLWH), people who use drugs (PWUD), and sex workers who are criminally prosecuted in Iowa
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Ensure that public health data are used only for public health purposes
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Improve processes for how populations are prioritized for HIV prevention activities
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Improve quality of life for PLWH
Process for Community Engagement
Engagement Focus
The stigma focus area co-chairs will discuss policies and practices that are stigmatizing for people living with or vulnerable to HIV. Then we will discuss strategies to address those policies and practices and ways to alleviate stigma that can result in poor health outcomes.
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This focus area will also gather information from community partners throughout the state to better understand the impact of and strategies to address stigma.
What we learn will inform and support our work in the following areas:
Meaningful involvement
Increase meaningful involvement of people living with HIV/AIDS (MIPA) in the creation of policies, services, research, & initiatives that impact them.
Decriminalizing HIV
Reduce the number of people living with HIV, people who use drugs, and sex workers who are criminally prosecuted in Iowa
Structuring stigma response
Develop a coordinated stigma plan for the state that includes training, marketing, and monitoring our progress.
Confidentiality of public health data
Ensure that public health data are used only for public health purposes
Prioritization of populations
Improve processes & community involvement in the prioritization of populations for HIV prevention & care activities
Improving quality of life
Improve quality of life for all people living with HIV
Gathering Feedback
Focus Groups and Key Informant Interviews
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People living with HIV (PLWH)
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Community HIV/Hepatitis Advocates of Iowa Network (CHAIN)
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Positive Iowans Taking Charge (PITCH)
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Harm reduction coalitions
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Iowa HIV and Hepatitis Community Planning Group (CPG)
This focus area will also partner with other focus areas to collect information about meaningful involvement of people living with HIV and other communities.
Resources
U.S. People Living with HIV Caucus
Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
Health Resources and Services Administration
Centers for Disease Control and Prevention
