Understanding the Roots and Cycle of Stigma Around HIV, TB, and Malaria

HIV, tuberculosis (TB), and malaria can be treated and controlled. However, stigma still discourages many people from getting tested or causes them to drop out of treatment midway. The fear of being judged—both in the surrounding community and within healthcare facilities—leads to late case detection and patients becominglost to follow up).

HIV/AIDS, tuberculosis (TB), and malaria—collectively known as ATM—are still frequently accompanied by misconceptions and stigma regarding their transmission and treatment. People living with these conditions also face the risk of privacy violations and unequal treatment at healthcare service facilities. Therefore, eliminating stigma is critical to achieving the elimination of ATM by 2030. 

All three diseases can be managed and their transmission prevented. However, misunderstandings breed prejudice and an "us versus them" mindset that can lead to discrimination—ranging from unequal service to refusal of medical care. Concerns about being judged cause patients to delay or avoid returning for treatment. As a result, diagnosis and treatment are delayed, health conditions worsen, and new transmissions can occur. Trust in healthcare facilities weakens, program targets are hindered, and societal stereotypes grow stronger, causing the cycle of stigma to persist. The Ministry of Health of the Republic of Indonesia has published Technical Guidelines for the Elimination of Stigma and Discrimination in Healthcare Facilities since 2012 as a reference for providing services that respect patient dignity.

Stigma does not appear out of nowhere. It grows from multiple layers, ranging from individual perspectives to institutional regulations.

The first layer exists within healthcare workers themselves. Misinformation—such as the belief that HIV can be transmitted through a handshake—frequently triggers excessive fear. The impact is visible in practice: staff use excessive personal protective equipment, limit physical contact, or even refuse to provide services. Judgment toward patients can also be influenced by personal values and experiences that are not managed professionally.

The social environment also shapes these perspectives. Cultural and religious norms in society influence how a disease is perceived. The media plays a major role as well. Inaccurate news coverage and stigmatizing terms reinforce stereotypes. Conversely, person-first language that puts humanity ahead of the disease—such as "people living with HIV" instead of "HIV sufferers"—has been proven to help erode stigma.

At the healthcare facility level, issues are often systemic. Standard procedures that differentiate patients without a scientific basis still exist. Training and supervision are minimal, while workloads remain high. Under such conditions, discriminatory practices gradually become normalized.

The outermost layer consists of policies and social structures. Regulations that restrict or criminalize specific groups, power dynamics imbalances, and poverty cause stigma to become deeply rooted and difficult to break.

Stigma generally does not stem from bad intentions, but rather from erroneous beliefs and habits that are taken for granted. Breaking this cycle requires enhancing the competence of healthcare workers, patient-centered communication, policies that protect patient rights, and an inclusive organizational culture. 

Fundamentally, every patient is entitled to care that respects their dignity regardless of their background, and every clinical decision should be based on medical need and professional standards, not prejudice. 

Eliminating stigma in healthcare facilities cannot be placed solely on the shoulders of healthcare workers. Behavioral change among staff must be supported by firm leadership, policies that uphold patient rights, responsive services, and cross-sector collaboration.

(Photo by Tima Miroshnichenko from Pexels)