Achieving Health Equity to End the Epidemics: Ending Stigma and Discrimination
In September 2016, NASTAD made a commitment to Black lives with its “Black Lives Matter” credo. This credo states that “discriminatory public and political infrastructure, including population health systems, prevents equitable health outcomes.” NASTAD stands by this statement and continues to work to end stigma and discrimination in public health systems in order to achieve health equity for all people.
Stigma and discrimination in the public health space derives from decades of systemic oppression against marginalized communities, which include, but are not limited to, the Black, Latinx, LGBTQ+, and low-income communities, sex workers, people who use drugs (PWUD), and people living with HIV (PLWH) and other infectious diseases. Studies show that communities that are stigmatized and discriminated against are less likely to receive access to quality health services. According to UNAIDS, roughly one in eight PLWH worldwide is being denied health services because of stigma and discrimination. Public health officials who want to end stigma and discrimination and achieve health equity must build trust with these marginalized communities, and meet them where they are.
Educating individuals about the culture and background of marginalized communities – and seeking education from those communities -- can be the first step in debunking the myths and misinformation that increase stigma and discrimination. For example, there are people who are not educated about HIV and falsely believe that HIV infection is the result of personal irresponsibility or moral fault. These beliefs can leave PLWH feeling isolated. It is time for all people to understand that a person who is virally suppressed CANNOT transmit HIV to others. Education about HIV transmission, prevention, care, and treatment can lead to more understanding and less stigmatizing beliefs towards PLWH. There are various resources, such as NASTAD and NCSD’s Addressing Stigma Toolkit, that educate public health officials and health care providers on how to create inclusive and affirming experiences for patients and clients.
Studies show that stigma and discrimination cause marginalized communities to be reluctant to seek care that can improve their health or save their lives. These communities have formed a mistrust towards public health systems. For example, discriminatory events in history, such as Henrietta Lack’s cells and the Tuskegee experiment, have been shown to be the reason that many Black people feel little trust in their physicians or fail to seek medical care. Ending stigma and discrimination will increase the likelihood that individuals in marginalized communities seek advice, care, and treatment from providers because a non-judgmental attitude shows that the providers are understanding and working in the patients’ best interest. WellVersed.org and HisHealth.org are resources that health care providers can utilize to learn how to build trusting relationships with the Black men who have sex with men (MSM) community. These resources can help bridge the communication gap between the patient and provider to create an environment where everyone is seen as human and equal.
We will have achieved health equity when marginalized communities achieve optimal health outcomes, their needs are understood, and the health disparities that these communities face are eliminated. Ending stigma and discrimination is imperative to achieve these goals, and ultimately, to end the epidemics.