Despite transformative advances in HIV treatment and the unequivocal evidence supporting undetectable equals untransmittable (U=U), stigma remains a persistent and damaging barrier to care. For many people living with HIV, experiences of judgement, fear and exclusion continue to shape clinical encounters, disclosure decisions and long-term wellbeing. As HIV increasingly becomes a manageable long-term condition, the responsibility to address stigma extends beyond biomedical success to the way care is delivered, language is used and communities are engaged.
In this practice pearl Q&A, we talked with Dr Lydia Efobi (University of Nigeria, Nsukka, Nigeria), an early-career HIV specialist as she reflects on where stigma persists in modern practice. She outlines practical, people-centred approaches to dismantling it within everyday HIV care.
Q. Where do you think stigma most commonly persists in clinical practice, despite effective treatment and U=U, and how does it affect engagement in care?
In my experience in clinical practice, stigma most commonly persists among healthcare professionals themselves, the very people entrusted with care. While our treatments are remarkably effective, the person delivering that care determines whether it reaches those who need it. It becomes profoundly concerning when nurses practise unnecessary social distancing from people living with HIV, despite knowing that routine interaction poses no transmission risk.
If providers cast judgemental glances at young people collecting their antiretroviral refills, their assumptions about promiscuity and moral failing are written across their faces.
This stigma has measurable consequences and often forces people to delay seeking care, miss appointments and disengage from treatment entirely. We cannot achieve viral suppression in populations we have first pushed away. The irony is devastating: we have the science to end transmission, yet our prejudice ensures it continues.
Q. How do issues such as disclosure, sexual health and long-term relationships continue to shape stigma for people living with HIV?
The outcome of disclosure remains a gamble, with one’s entire social world at stake. One person may disclose and receive warmth and support; another may watch their relationships dissolve overnight, becoming an outcast in their own community. This fear of the unknown is grounded in the lived reality of countless people living with HIV who have lost jobs, families and partners following disclosure.
In sexual relationships, undetectable equals untransmittable (U=U) should have revolutionized intimacy for people living with HIV. Yet knowledge of U=U remains inadequately disseminated, leaving people to navigate disclosure conversations armed with science their partners have never heard of. The burden of education falls on those already vulnerable, and this in itself is a manifestation of stigma.
Q. What role do HIV services themselves play in either reinforcing or reducing stigma, and what changes have you seen (or would like to see) in how care is delivered?
HIV services can either liberate or oppress; there is no neutral ground. Effective prevention and treatment services offer tangible hope towards the 2030 goals, but only when delivered without judgement and with genuine community partnership.
Widespread communication about U=U can transform society’s understanding, allowing people living with HIV to exist without stigmatising labels. However, this requires intentional effort, including grassroots education, appropriate sensitisation and dismantling the hierarchies that have historically excluded the very communities most affected.
The changes we urgently need include positioning key populations as decision-makers, rather than research subjects to be studied and spoken for. We must involve people living with HIV in designing the services intended to serve them. When we rebuild community trust through genuine partnership, rather than extractive research relationships, we create resilience that transcends funding cuts and political shifts. This is what competent public health practice should look like.
Q. As HIV increasingly becomes a long-term condition, how can HIV clinicians better address stigma linked to ageing, multimorbidity and mental health?
Counselling sessions must become standard practice at every clinical encounter, rather than an afterthought. These sessions should address the holistic reality of living with HIV: the intersection of physical health, mental wellbeing and the cumulative burden of chronic conditions. For older populations, multimorbidity is nearly universal. While we cannot prevent every comorbidity, we can significantly reduce harm through proactive, integrated care that treats the whole person.
Language matters profoundly. Person-first language, such as saying “people living with HIV” rather than “HIV patients” or, worse, “HIV cases”, acknowledges humanity before diagnosis. It is a small shift with meaningful psychological impact.
Perhaps most critically, we must recognize that community connection is a clinical intervention, not merely a social nicety. Peer support networks reduce isolation, improve adherence and provide a level of understanding that clinicians, however well intentioned, cannot always offer. We should be prescribing community alongside antiretrovirals.
Q. From your perspective as an early-career HIV specialist, what practical steps can HIV teams take to embed stigma reduction into everyday practice rather than treating it as a separate issue?
Youth involvement cannot be relegated to tokenism or afterthought panels. Young people bring fresh perspectives unburdened by “we have always done it this way” thinking. Our minds are wired for innovation; why would you not harness that? Interactive approaches, such as gamification, can transform stigma-reduction training from tedious tick-box exercises into dynamic problem-solving that genuinely changes behaviour.
Most importantly, key populations must hold decision-making power within the systems that govern their care. This is both an ethical imperative and a pragmatic necessity. Why would we make decisions on behalf of communities when we could involve them directly? They hold the lived experience, community trust and cultural knowledge that no amount of academic training can replicate. They know which interventions will be accepted, which language will resonate, and which barriers are genuinely insurmountable versus merely assumed.
Embedding people living with HIV and key populations into HIV teams, not as patients or subjects but as colleagues, advisers and leaders, transforms stigma reduction from an add-on initiative into the foundation of care itself. This is how we move from treating HIV to truly ending AIDS.
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Cite: Lydia Efobi. Reducing HIV stigma in clinical practice. touchINFECTIOUS DISEASES. 27 January 2026.
Editor: Katey Gabrysch, Editorial Director.
Disclosures: The content was developed and edited by human editors. No fees or funding were associated with its publication. touchINFECTIOUS DISEASES utilize AI as an editorial tool (ChatGPT (GPT-4o) [Large language model]. https://chat.openai.com/chat).
This content has been developed independently by Touch Medical Media for touchINFECTIOUS DISEASES. Views expressed are the speaker’s own and do not necessarily reflect the views of Touch Medical Media.
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