Discriminatory attitudes towards people living with HIV
Progress towards reducing discriminatory attitudes and support for discriminatory policies
Discrimination is a human rights violation prohibited by international human rights law and most national constitutions. Discrimination in the context of HIV refers to unfair or unjust treatment (an act or an omission) of an individual based on his or her real or perceived HIV status. Discrimination exacerbates risks and deprives people of their rights and entitlements, fuelling the HIV epidemic. This indicator does not directly measure discrimination but rather measures discriminatory attitudes that may result in discriminatory acts (or omissions). One item in the indicator measures the potential support by respondents for discrimination that takes place at an institution and the other measures social distancing or behavioural expressions of prejudice. The composite indicator can be monitored as a measure of a key manifestation of HIV-related stigma and the potential for HIV-related discrimination within the general population. This indicator could provide further understanding and improve interventions in HIV discrimination by: showing change over time in the percentage of people with discriminatory attitudes; allowing comparisons between national, provincial, state and more local administrations; and indicating priority areas for action.
Number of respondents (15–49 years old) who respond no to either of the two questions
Number of all respondents (15–49 years old) who have heard of HIV
Population-based surveys (Demographic and Health Survey, AIDS Indicator Survey, Multiple Indicator Cluster Survey or other representative survey). This indicator is constructed from responses to the following questions in a general population survey from respondents who have heard of HIV.
- Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV? (yes, no, don’t know/not sure/it depends)
- Do you think that children living with HIV should be able to attend school with children who are HIV negative? (yes, no, don’t know/not sure/it depends)
Every 3–5 years
- Age (15–19, 20–24 and 25–49 years)
- Gender (male, female)
- Responses for each question (based on the same denominator) are required as well as the consolidated response for the composite indicator
The respondents who have never heard of HIV and AIDS should be excluded from the numerator and denominator. Participants who respond don’t know/not sure/it depends and those who refuse to answer should also be excluded.
Yes and no responses to each question may not add up to 100% if any participants respond “don’t know” or values are missing. Calculating the percentage of people responding no to this question by subtracting the percentage of yes responses from 100% would therefore be inaccurate.
This indicator directly measures discriminatory attitudes and support for discriminatory policies.
The question about buying vegetables is virtually identical to one used in a Demographic and Health Survey for monitoring “accepting attitudes” towards people living with HIV, enabling continued monitoring of trends. This question, however, focuses on “no” (discriminatory attitudes) rather than “yes” (accepting attitudes) responses, improving the previous measures for the “accepting attitudes” indicator, since it is applicable in settings with both high and low HIV prevalence and in high-, middle- and low-income countries and is relevant across a wide cultural range. Individual measures and the composite indicator do not rely on the respondent having observed overt acts of discrimination against people living with HIV, which are rare and difficult to characterize and quantify in many contexts. Rather, the individual measures and the composite indicator assess an individual’s attitudes, which may more directly influence behaviour.
The recommended questions assess agreement with hypothetical situations rather than measuring events of discrimination witnessed. Social desirability bias may therefore occur, leading to underreporting of discriminatory attitudes. There is no mechanism for examining the frequency with which discrimination occurs or its severity.
Ideally, in addition to conducting surveys that measure the prevalence of discriminatory attitudes in a community, qualitative data should be collected to inform about the origins of discrimination. It would also be advisable to routinely collect data from people living with HIV on their experiences of stigma and discrimination via the People Living with HIV Stigma Index process (www.stigmaindex.org) and to compare the findings with the data derived from the discriminatory attitudes indicator.
Stangl A, Brady L, Fritz K. Technical brief: measuring HIV stigma and discrimination. STRIVE. Washington DC and London: International Center for Research on Women and London School of Hygiene and Tropical Medicine; 2012 (http://strive.lshtm.ac.uk/system/files/attachments/STRIVE_stigma%20brief...).
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/).
Thematic segment: non-discrimination. Background note. In: Thirty-first meeting of the UNAIDS Programme Coordinating Board, Geneva, 11-13 December 2012. Geneva: UNAIDS; 2012 (http://www.unaids.org/en/media/unaids/contentassets/documents/pcb/2012/20121111_PCB%2031_Non%20Discrimination_final_newcoverpage_en.pdf).
For more on the methods and survey instruments for the Demographic and Health Survey and AIDS Indicator Survey: http://dhsprogram.com.
This indicator provides an important measure of prevalence of discriminatory attitudes towards people living with HIV. More completely assessing progress towards eliminating HIV-related stigma and discrimination and the success or failure of efforts to reduce stigma requires measuring other domains of stigma and discrimination.