General Articles

Combating Stigma to Combat HIV Infection: Going Beyond Individual Behavior Change

Sean Cahill, Robert Valadez, Sabina Ibarrola, “Community-Based HIV Prevention Interventions that Combat Anti-Gay Stigma for Men Who Have Sex with Men and for Transgender Women,” Journal of Public Health Policy (November 2012).

Since HIV prevention programs first emerged in the wake of the AIDS epidemic over 30 years ago, risk-reduction efforts have prioritized changing individual sexual and drug-use behaviors of men who have sex with men (MSM). The authors argue that the next 30 years will require the development of new interventions that focus on changing community-level and structural-level bias and discrimination against MSM and transgender women.

Key Findings

  • Gay-Straight Alliances (GSAs) are the most common community-level interventions used in school settings, with more than 4,000 GSAs registered across the U.S.
  • Family-acceptance interventions show promise for reducing stigma and strengthening ties between parents and LGBT youth; so far, public service and social marketing campaigns are the most common ways that family-acceptance has been promoted.
  • Involving transgender women in the creation of behavior-change interventions, and in the creation of awareness campaigns about transgender legal rights, has the potential to empower transgender women to combat stigma and take charge of their sexual health.

Numerous evidence-based interventions have been developed and replicated to change high-risk sexual behaviors among individuals at greatest risk for HIV infection. The authors make the case that future interventions should focus less on changing individual risk behaviors and more on changing society-wide attitudes that stigmatize those at highest risk for HIV: “A key structural driver [of HIV infection] is anti-gay stigma.”[1]

By promoting a safer and more supportive social, legal, and economic environment for people of all sexual orientations and gender identities, we can potentially strengthen the social bonds that help all people to take charge of their sexual health and advocate for their sexual rights, thereby avoiding fatalism and reducing HIV infection risk. If the authors are correct, those most likely to benefit from stigma-reducing interventions are men who have sex with men and transgender women.

The authors draw from a growing body of public health evidence to show the benefits of combating stigma through strength-based messaging and asset-based programming (e.g. family-acceptance campaigns that emphasize a parent’s unconditional love for their child; GSAs intended to bring together youth with shared interests). As with GSAs that increase community connectedness for school-age youth, social groups and activities for older MSM and transgender women can also reduce social isolation and increase self-esteem in ways that are likely to reduce HIV infection risks (e.g. reducing problem drinking or other drug use among people who feel socially isolated in older age).

The authors point out the importance of involving representatives of at-risk communities in the design of interventions to combat stigma. People who have experienced stigma first-hand are best qualified to propose the messages and activities most likely to change public attitudes. This article can therefore be understood as an appeal to community-level participation in designing the next wave of community-level interventions.

[1]Cahill S, Valadez R, Ibarrola S (2012). Community-based HIV prevention interventions that combat anti-gay stigma for men who have sex with men and for transgender women. J Public Health Policy, 15 November 2012, doi:10.1057/jphp.2012.59, <>.