Stigma is a powerful, sometimes unseen force. And most of us experience it in some way or another.

Those working in the HIV space realize that stigma is an immense barrier to HIV testing and treatment. We talk about it, we advise everybody to eradicate it, and we discuss how training has the ability to enhance someone’s well-being and improve results for the communities most at risk in terms of contracting HIV.

Stigma can impede the realization of HIV/STI prevention on the ground — specifically when it comes to clean needle exchanges and safe places to inject.

The Yale School of Public Health conducted a study examining whether or not Indiana’s 2011-2015 HIV outbreak in Scott County — spread largely through drug needles — could have been prevented or reduced. The authors concluded that if a clean needle exchange had been started in the early years of the emergency, the resulting diagnoses would have fallen to a third of the 2015 total.

Instead, the government of Indiana cut funding to the last HIV testing center in the county and did not declare a public health emergency until the number of infections had already fallen.

It is no coincidence that the avoidable tragedy of Scott County’s HIV outbreak was an intersection of two highly-stigmatized conditions in our society: HIV-positive status and drug addiction.

We live in a world where drug addicts are treated like criminals more often than they are treated like people with a disease, and HIV-positive people are treated with moral reproach. Maybe Indiana state officials were afraid of how it’d look for them to launch a clean needle exchange program, despite the immense amount of data showing that such programs work.

Maybe that’s why they ignored local public health leaders’ warnings and let the situation spiral out of control.

What always takes my breath away is that almost every social standard, approach and frame of mind can influence the spread of HIV, since HIV does not spread in a vacuum.

The HIV pandemic is specifically coupled with unnecessary stigma, and social equity is harmed.

Ending HIV-related stigma requires considerably more effort than showing individuals how to discuss HIV in a delicate, capable way. HIV stigma incorporates social determinants: race and ethnicity, salary level, instruction level, sex and sexual identity, among others.

If we want to end stigma so that we can stop similar emergencies by utilizing harm reduction options, we need to be having open discussions about sexuality, racial injustices, drug abuse and gender identity.

And beyond those conversations, we need to reject stigma.

This notion has been written about academically for decades, but we need to make it a priority for those with political power, keeping in mind that “the attribution of and internalization of stigma can reduce the effectiveness of prevention and harm reduction activities: that the stigmatization of client populations affects how they are treated and that the internalization of stigma by the client (or potential client populations) prevents them from accessing or fully utilizing the services on offer (Fitzgerald, McDonald, & Klugman, 2004; National Aids Trust, 2003).”

Josh Robbins is an award-winning sexual health advocate, author of the site and spokesperson for He was nominated for a GLAAD media award in 2017 and recently won the National Lesbian and Gay Journalist Association’s Excellence Award in the blogging category.