Stigma and discrimination against key populations and persons living with or at risk of HIV occurs within families as well as the wider community and in healthcare settings. It encompasses a wide range of discriminatory behavior and attitudes including (but not limited to) isolation and exclusion from family and community activities, physical and verbal abuse, and harassment. Unfortunately, these abuses are also present in health care settings with care providers criticizing, blaming, shaming, and even refusing to provide care to people living with HIV (PLHIV). 

The Sustainable Development Goals (SDGs) have set ambitious targets for ending the AIDS epidemic by 2030. In this regard, stigma and discrimination are entrenched social challenges that must be overcome to ensure better coverage and uptake of HIV prevention and treatment services by key populations. In 2024, UNDP supported the Association for People Living with HIV to carry out the HIV Stigma Index Study 2.0 - the first PLHIV Stigma Index in Pakistan was conducted in 2009-10. The HIV Stigma Index is a standardized global methodology to understand how PLHIV experience stigma and discrimination along with its impact on their lives. 

The PLHIV Stigma Index study is a PLHIV community led process that uses participatory and operational research methods to create empirical evidence for understanding the impact of stigma and discrimination on the lives of people affected by HIV, addressing gaps, guiding advocacy efforts, and shaping policies and promoting accountability amongst gatekeepers and decision makers.

Key Survey Findings

1. Prevalence of stigma and discrimination: A total of 1,500 (22% Women and 12% Transgender) PLHIV across all provinces and the federal capital, Azad Jammu & Kashmir and Gilgit Baltistan were interviewed in the survey.  Of these, 17% reported discrimination by family members after learning about their status; these included verbal harassment (11%), blackmailing (4%), and physical harassment (6%). Furthermore, around 5% of the respondents lost a source of livelihood due to their HIV status, 10% reported being pressured to take an HIV test, 3% went through non-consensual testing, and 20% were tested without their knowledge.

2. The marginalized among the marginalized: Access to healthcare remains a key challenge for PLHIV and key populations because of their HIV status, identity, behaviors, or social attributes.  Among key populations, People Who Use Drugs (PWUD) experienced the most stigma (compared with other key population groups) due to their HIV status, with 22% PWUD being excluded from family activities and 19% reporting challenges in accessing healthcare services (due to fear of stigma and discrimination by healthcare workers).  

3. Inadequate Social Protection: The study revealed shocking facts around human rights violations and lack of access to reporting or response from relevant authorities. More than 50% of PLHIV who faced abuse or discrimination did not know where to go for help, 14% said they had little or no confidence that the outcome would be successful, and 13% cited insufficient financial resources as a barrier to seeking remedial action. The study revealed that there was a total of 223 human rights violations in 2022-23 that PLHIV experienced, of which only 16 (7%) were reported.  Of these, 11 respondents reported that no action was taken on their complaints, 3 stated that the matter was pending with the authorities, and only 2 informed about positive action leading to resolution of the issue. The study also identified stigma and discrimination among healthcare workers as a common reason deterring key populations from seeking support. Finally, there is strong evidence that the mental health of PLHIV is compromised and a contributing factor for PLHIV in treatment initiation.

4. Action to Evidence: The study presents a robust advocacy and action plan that gives primacy to community centered HIV care aimed at addressing the social and psychological factors that undermine access to health services for key populations. It provides opportunities to decision makers, planners, and healthcare administrators in ensuring that policies, systems, operations, and responses are effective in addressing HIV associated stigma and discrimination. The Report also calls for promulgating provincial HIV laws for reducing human rights violations along with a Stigma Monitoring Framework to improve the effectiveness of national level stigma reduction interventions. 

For detailed report and further gender disaggregated findings, access full report here.

Author:                                                                                    

Summayyah Rasheed                                                           

Programme Officer Stigma & Discrimination, Global Fund HIV Project Management Unit 
United Nations Development Programme  

Co-Author:

Asghar Satti

National Coordinator, The Association for People

Living with HIV (APLHIV) Pakistan