Tackling structural stigma: a systems perspective

Graham Brown; Daniel Reeders; Aaron Cogle; Brent Allan; Chris Howard; John Rule; Susan Chong; Deborah Gleeson

doi:10.1002/jia2.25924

Tackling structural stigma: a systems perspective

J Int AIDS Soc. 2022 Jul;25 Suppl 1(Suppl 1):e25924. doi: 10.1002/jia2.25924.

Authors

Graham Brown^{1

2

3}, Daniel Reeders^{4

5}, Aaron Cogle⁵, Brent Allan^{6

7}, Chris Howard⁸, John Rule^{5

9}, Susan Chong¹⁰, Deborah Gleeson¹⁰

Affiliations

¹ Centre for Social Impact, University of New South Wales, Sydney, New South Wales, Australia.
² Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia.
³ Collaboration for Evidence, Research and Impact in Public Health, Curtin University, Perth, Western Australia, Australia.
⁴ School of Regulation and Global Governance, Australian National University, Canberra, Australian Capital Territory, Australia.
⁵ National Association of People Living with HIV Australia, Sydney, New South Wales, Australia.
⁶ Qthink Consulting, Melbourne, Victoria, Australia.
⁷ Formerly of Living Positive Victoria, Melbourne, Victoria, Australia.
⁸ Queensland Positive People, Brisbane, Queensland, Australia.
⁹ School of Population Health, University of New South Wales, Sydney, New South Wales, Australia.
¹⁰ School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia.

Abstract

Introduction: Structural stigma in the global HIV response is a "moving target" that constantly evolves as the epidemic changes. Tackling structural stigma requires an understanding of the drivers and facilitators of stigma in complex community, policy and health systems. In this paper, we present findings from a study adopting a systems perspective to understand how to tackle structural stigma via the Meaningful Involvement of People with HIV/AIDS (MIPA), while highlighting the challenges in demonstrating peer leadership from people living with HIV (PLHIV).

Methods: Through a long-term ongoing community-research collaboration (2015-2023), the study applied systems thinking methods to draw together the insights of over 90 peer staff from 10 Australian community and peer organizations. We used hypothetical narratives, affinity methods and causal loop diagrams to co-create system maps that visualize the factors that influence the extent to which peer leadership is expected, respected, sought-out and funded in the Australian context. We then developed draft indicators of what we should see happening when PLHIV peer leadership and MIPA is enabled to challenge structural stigma.

Results: Participants in the collaboration identified the interactions at a system level, which can enable or constrain the quality and influence of PLHIV peer leadership. Participants identified that effective peer leadership is itself affected by structural stigma, and peer leaders and the programmes that support and enable peer leadership must navigate a complex network of causal pathways and strategic pitfalls. Participants identified that indicators for effective PLHIV peer leadership in terms of engagement, alignment, adaptation and influence also required indicators for policy and service organizations to recognize their own system role to value and enable PLHIV peer leadership. Failing to strengthen and incorporate PLHIV leadership within broader systems of policy making and health service provision was identified as an example of structural stigma.

Conclusions: Incorporating PLHIV leadership creates a virtuous cycle, because, as PLHIV voices are heard and trusted, the case for their inclusion only gets stronger. This paper argues that a systems perspective can help to guide the most productive leverage points for intervention to tackle structural stigma and promote effective PLHIV leadership.

Keywords: PLHIV; community; peer; stigma; structural; systems.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Acquired Immunodeficiency Syndrome*
Australia
HIV Infections*
Humans
Peer Group
Social Stigma