Stigma and discrimination experienced by key populations (A-D)
This indicator is divided into four sub-indicators:
A. Experience of stigma and discrimination among sex workers.
B. Experience of stigma and discrimination among gay men and other men who have sex with men.
C. Experience of stigma and discrimination among people who inject drugs.
D. Experience of stigma and discrimination among transgender people.
What is measures
Progress towards reducing experiences of stigma and discrimination among key populations
Key population stigma is a negative stereotype based on an individual belonging to a key population group. Stigma is a well-documented barrier to the HIV care continuum, creating gaps across the prevention and treatment cascades, particularly for key populations (including sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people). Key population stigma results from a range of drivers and facilitators, including: negative and judgmental attitudes towards key populations; shame related to an individual's ooccupation, drug use, or sexual and gender identity; and social, cultural and gender norms. These manifest in a range of stigmatizing practices and experiences, including discrimination, that deny key populations full social acceptance, consequently reducing their life chances, deterring them from accessing essential services and fuelling social inequalities.
Reducing HIV stigma and discrimination experienced by key populations is critical for increasing HIV testing, uptake of and adherence to antiretroviral therapy, and viral suppression, all of which will improve their health outcomes.
Number of people in the key population group (sex workers, gay men and other men who have sex with men, people who inject drugs or transgender people) who report that one or more of four experiences has happened to them in the last six months because of their key population status
Total number of respondents from the key population group
Behavioural surveillance or other special surveys. This indicator is constructed from responses to the following questions among respondents who report belonging to a key population group (i.e., sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people).
- Have you ever felt excluded from family activities because you [sell sex; have sex with men; inject drugs; are transgender]? (no; yes, in the last six months; yes, but not in the last six months; don't know).
- Has someone ever scolded you because you [sell sex; have sex with men; inject drugs; are transgender]? (no; yes, in the last six months; yes, but not in the last six months; don't know).
- Has someone ever blackmailed you because you [sell sex; have sex with men; inject drugs; are transgender]? (no; yes, in the last six months; yes, but not in the last six months; don't know).
Every two years
- A, B, C, D: age (<25, 25+ years).
- A and C: gender (male, female, transgender).
- D: gender (transman, transwoman, other).
Submit the digital version of any available survey reports using the upload tool. The report submitted with this indicator should include information on the sample size, the quality and reliability of the data, and any related issues.
These indicators directly measure experienced stigma and discrimination among sex workers, gay men and other men who have sex with men, people who inject drugs and transgender people. These are important manifestations of stigma that have been demonstrated to impede HIV prevention, care and treatment services among key populations.
The indicators are calculated from responses to three questions. The questions were developed by technical experts based on previously validated measures of key population stigma and discrimination used in primary research studies.
Changes in the indicator should be interpreted as follows: an increase in the percentage indicates an increase in experienced stigma and discrimination among key populations and a need for mitigating action, whereas a decrease in the percentage indicates progress and a reduction in experienced stigma and discrimination among key populations.
Respondent-driven sampling (RDS) is used to implement integrated biobehavioural surveys. This sampling methodology allows researchers to access, in a systematic way, members of typically hard-to-reach populations who may not otherwise be accessible. Because RDS is a probability sampling method, researchers are able to provide unbiased population estimates as well as measure the precision of those estimates. RDS can be especially successful at rapid recruitment in dense urban environments, but in contexts where the hard-to-reach populations are not well-networked, or in contexts where the stigma associated with some key populations is severe, recruitment rates using RDS may be unpredictable. Other disadvantages to using RDS relate to the difficulties that may arise when analysing collected data. For instance, since RDS must take into account weighting for network size and recruitment patterns, the statistical strength of the sample as it applies to the target population decreases if participants only recruit people who share the same characteristics as themselves.
Friedland B, Sprague L, Nyblade L, Baral S, Pulerwitz J, Gottert A et al. Measuring intersecting stigma among key populations living with HIV: implementing the people living with HIV Stigma Index 2.0. J Int AIDS Soc. 2018;21(S5):e2513.1 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055043/).
Stahlman S, Hargreaves J, Sprague L, Stangl A, Baral S. Measuring sexual behaviour stigma to inform effective HIV prevention and treatment programmes for key populations. JMIR Public Health Surveill. 2017;3(2):e23 (https://publichealth.jmir.org/2017/2/e23/).
For more on the methods and survey instruments for the integrated biobehavioural survey, see: (https://apps.who.int/iris/bitstream/handle/10665/258924/9789241513012-eng.pdf).