Avoidance of health care among key populations because of stigma and discrimination (A–D)

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Avoidance of health care among key populations because of stigma and discrimination
What it measures
This indicator is divided into four subindicators:
A. Avoidance of health care by sex workers because of stigma and discrimination.
B. Avoidance of health care by gay men and other men who have sex with men because of stigma and discrimination.
C. Avoidance of health care by people who inject drugs because of stigma and discrimination.
D. Avoidance of health care by transgender people because of stigma and discrimination.

What it measures

Progress towards reducing discriminatory attitudes and support for discriminatory policies in health-care settings.



Discrimination is a human rights violation and is prohibited by international human rights law and most national constitutions. In the context of HIV, discrimination refers to unfair or unjust treatment of an individual (either through actions or by failure to act) based on his or her real or perceived HIV status. Discrimination exacerbates risks and deprives people of their rights and entitlements, thus fueling the HIV epidemic. HIV-related stigma refers to negative beliefs, feelings and attitudes towards people living with HIV, groups associated with people living with HIV (e.g., the families of people living with HIV) and other key populations at higher risk of HIV infection, such as people who inject drugs, sex workers, gay men and other men who have sex with men and transgender people. In addition to HIV-related stigma, people from key populations experience further discrimination because of the stigma relating to same-sex attraction and sexual behaviour, engagement in sex work, drug use and non-conforming or diverse gender expression.

This indicator is important for providing a measure of the proportion of members of key populations who have avoided accessing general healthcare services, due to fear of stigma and discrimination. Related reasons for avoiding such services may include (but are not limited to) the following: a lack (or perceived lack of) confidentiality within health-care settings; negative attitudes and behaviours among health-care providers; and fears of disclosing or hinting at individual behaviours and sexual preference/orientation.

Data related to the avoidance of health-care services are important in measuring the proportion of key populations who are not fulfilling their basic health-care needs (such as routine medical check-ups) and thus may be less likely to attend health-care settings for more specialized services and care (such as HIV testing, treatment and medical care). This indicator is important for understanding and addressing the barriers to achieving the 95–95–95 targets among members of key populations. Data from this indicator directly measure fear of stigma or discrimination.

This indicator could provide further understanding and improve interventions in reducing HIV stigma and discrimination by (1) showing change over time in the percentage of people who fear experiencing stigma, (2) enabling comparisons between national, provincial, state and more local administrations, and (3) indicating priority areas for action



Number of respondents who reported having avoided seeking healthcare in the last 12 months.

Avoidance of services due to fear of stigma and discrimination may be asked in different ways across countries/surveys.



Number of respondents



Method of measurement

Behavioural surveillance or other special surveys

Measurement frequency

Every two years

  • A–D: Age (<25 and 25+ years).
  • A and C: Gender (female, male and transgender).
  • D: Gender (transman, transwoman, other)
Additional information requested

Please provide the questions included in the survey instruments.

If there are subnational data available, please provide the disaggregation by administrative area, city, or site in the space provided. Submit the digital version of any available survey reports using the upload tool.


Strengths and weaknesses

As a measure of stigma and discrimination, this indicator focuses on the outcomes of such behaviour. If perceived or experienced stigma and discrimination is sufficiently severe enough to dissuade people from seeking necessary health services, not only can it readily be identified as a problem, but it also affects critical service uptake. Some respondents, however, may experience and perceive important stigmatizing and discriminatory behaviour in their communities but, because of their own resilience or discrete or specialized services, may still seek out services. The indicator is not going to measure achieving zero discrimination but can inform on whether discrimination is reducing service uptake.

Further information
Global HIV Strategic Information Working Group. Biobehavioural survey guidelines for populations at risk for HIV. Geneva: World Health Organization; 2017 (https://apps.who.int/iris/bitstream/handle/10665/258924/9789241513012-en...).
For further information on stigma and discrimination, and efforts to measure their prevalence, please see: Thematic segment on non-discrimination, 31st meeting of the UNAIDS Programme Coordinating Board. Background note. Geneva UNAIDS; 2012 (http://www.unaids.org/en/media/unaids/ contentassets/documents/pcb/2012/20121111_PCB%2031_Non%20Discrimination_final_newcoverpage_en.pdf, accessed 21 November 2017).
Confronting discrimination: Overcoming HIV-related stigma and discrimination in health-care settings and beyond. Geneva: UNAIDS; 2017 (http://www.unaids.org/sites/default/files/media_asset/confronting-discri..., accessed 21 November 2017).
Stangl A, Brady L, Fritz K. Technical brief: measuring HIV stigma and discrimination. Washington (DC) and London: International Center for Research on Women and London School of Tropical Medicine, STRIVE; 2012 (https://www.icrw.org/wp-content/uploads/2017/07/STRIVE_stigma-brief-A4.pdf).
Stangl A, Lloyd JK, Brady LM, Holland CE, Baral S. A systematic review of interventions to reduce HIV-related stigma and discrimination from 2002 to 2013: how far have we come? J Int AIDS Soc. 2013;16(3 Suppl. 2). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3833106/pdf/JIAS-16-18734.pdf
Related Indicators
SD.1 Avoidance of health care among key populations because of stigma and discrimination, 2020, WHO Consolidated HIV strategic information guidelines: driving impact through programme monitoring and management (https://www.who.int/publications/i/item/consolidated-hiv-strategic-information-guidelines).