Romanee Chaiwarith

Stigma and discrimination continue to hinder PWH from accessing healthcare and fully participating in society. This session focuses on the impact of stigma on key populations, including Black communities, GBQ men, PWIO, and female partners of MSM. Despite perceptions of progress, stigma persists and significantly affects the health of PWH.

Husbands highlighted that Black communities in Canada are disproportionately affected by HIV. Although they make up 5% of the population, they account for 25.5% of new cases. Strategies include research, community engagement, black leadership and multidisciplinary approaches to promote health equity. Tan emphasized that stigma is a major barrier for people with HIV (PWH) in accessing clinical services. Many avoid clinics for fear of being identified, judged or "in the system" The stigma stems from family and religious beliefs that lead to heteronormative morality. Reducing stigma in clinics will facilitate access to HIV care and improve health. Kiriazova reported on opioid agonist treatment (OAT) among people who inject opioids. OAT recipients report less stigmatization (27.6%) than non-recipients (54.8%). Barriers include misconceptions about OAT, readiness, limited sites, and negative staff attitudes. Scaling up OAT requires its integration into clinical services and psychological support. Li reported on the rising HIV prevalence among MSM in China, reaching 8% in 2023. A quarter of them have recently had female partners, and a quarter consistently use condoms. Psychological problems of MSM wives include depression and suicidal thoughts. Enhanced prevention includes empowering MSM, reducing the stigma of condoms and educating wives about HIV.

Stigma and discrimination remain key factors preventing PWH from accessing clinical care and participating freely in public life. This limits their ability to express opinions, assemble, and engage in activities that contribute to the political, social, and cultural development of their communities. This session addresses stigma in key populations and the associated challenges. To alleviate stigma and discrimination, efforts must include gathering more data on improving equity in these communities, enhancing infrastructure, and securing sufficient funding to support these initiatives.

Zaynab Essack

The symposium critically addressed persistent issues of stigma and discrimination against key and vulnerable populations accessing HIV services, highlighting the challenges posed by conservative pushback and decreasing civic space. It aimed to foster dialogue and collaboration to create a more inclusive and equitable healthcare environment.

The session featured diverse perspectives and experiences, emphasizing the multifaceted impacts of stigma and discrimination on accessing critical HIV and substance use services. Presentations by Drs. Husbands, Kiriazova, Kay Jin Tan, and Li underscored the impact of stigma and discrimination on Black communities in Canada, LGBTQ+ individuals, people who inject drugs, and people with HIV, contributing to decreased access to healthcare. They advocated for inclusive decision-making networks to promote health equity and active community participation. The compounded effects of increased marginalization and vulnerability were discussed. Policies and societal attitudes that restrict rights and freedoms were noted to exacerbate these challenges. Various healthcare contexts where stigma and discrimination are prevalent were explored, including clinical settings, community health programs, and public health policies. The need for culturally competent and inclusive healthcare services was emphasized. A significant portion of the discussion focused on fostering collaborative efforts to combat stigma and discrimination. This includes engaging with policymakers, healthcare providers, and community organizations to develop and implement inclusive strategies. An award ceremony titled "Me and My Healthcare Provider" recognized outstanding contributions and commitment to creating an inclusive and equitable healthcare environment.

The session effectively highlighted the pervasive nature of stigma and discrimination and their detrimental impact on accessing HIV services. It emphasized the necessity of using interdisciplinary frameworks to challenge traditional paradigms of race and gender identities. Integrating mental health and substance use services for people living with HIV and reimagining gender within healthcare services are crucial steps toward inclusivity. Structural stigma and discrimination were common threads, with calls to address these issues in contexts of intense criminalization. Continued advocacy and engagement with diverse stakeholders are essential to create a more equitable healthcare environment.