Stigma and mental health challenges remain barriers to good quality of life for people living with HIV in urban settings

London, 11 September 2019 – Key trends from the Fast-Track Cities Quality of Life Survey were presented today at the Fast-Track Cities 2019 conference in London, the first international gathering of more than 300 cities and municipalities worldwide that are committed to accelerating their responses to HIV–as well as tuberculosis (TB) and viral hepatitis – with the shared goal of ending urban HIV, TB, and viral hepatitis epidemics by 2030.1

Stigma and discrimination were identified as posing significant challenges to the wellbeing of PLHIV to varying degrees across all Fast-Track Cities surveyed. Negative trends are particularly high in sub-Saharan Africa and North America, where 51% and 48% of PLHIV, respectively, said they had experienced feelings of stigma and/or discrimination by their community in the past 12 months.i This figure was highest in Dar es Salaam (67%), Bamako (56%), Durban (52%), and Miami (50%). By contrast, the lowest levels reported were in Bangkok (14%) and Salvador de Bahia (17%).ii Across Europe, just under a third of respondents cited feeling stigmatised by their community in the last year.i

The survey also explored emotional challenges, including worries associated with HIV status disclosure. Globally, 40% of respondents stated they had“almost always” or “often” worried about disclosing their HIV status to friends or family members in the past year. This figure was particularly high in Bamako (65%) and Santiago (49%) and it was lowest in Berlin(9%). Findings suggest that this worry often extends to status disclosure to intimate partners or spouses, with 46% of respondents in Athens and over half of those surveyed in Nairobi having worried about disclosing their status to an intimate partner or spouse in the same timeframe. In New York City, respondents generally revealed higher levels of concern around disclosing their status to intimate partners and spouses than to friends or family members (24% versus 13% respectively).ii

Dr. José M. Zuniga, President/CEO of IAPAC, said: “Stigma and discrimination experienced in the context of healthcare provision, though not universally reported, is absolutely unacceptable. Healthcare workers have a critical role to play in providing a safe, supportive, and compassionate environment for PLHIV, which is known to support positive clinical outcomes, and respecting their dignity and human rights. These findings suggest that little progress has been made over the last decade, as they reveal similar trends to those identified in our 2010 AIDS Treatment for Life International Survey (ATLIS 2010). As a community of healthcare workers charged with the wellbeing of PLHIV, it is our duty to offer stigma-and discrimination-free health and supportive services.”

Robert Remien, Director of the HIV Centre for Clinical and Behavioural Studies in the Division of Gender, Sexuality, and Health, and Professor of Clinical Psychology at Columbia University in New York City, said: “We know that there are higher rates of mental health disorders among people who are vulnerable to acquiring HIV and among those living with HIV, with both biological and social determinants of these conditions. We also know that societal and interpersonal stigma and discrimination –both actual and perceived – are associated with psychological distress, while positive social support and provider-patient relationships are associated with increased feelings of wellbeing and improved quality of life. Thus, it is likely that similar structural and interpersonal factors that contribute to decreased distress and to positive wellbeing also contribute to better health outcomes along the HIV care continuum, and that there is synergy between improving psychological wellbeing and improving HIV health outcomes.”

Notes to editors:

About Fast-Track Cities and the Fast-Track Cities Quality of Life Survey
Cities and municipalities are home to large numbers of people living with HIV, among who are many belonging to key populations at higher risk of HIV but which often have limited access to HIV services. The Fast-Track Cities is a global partnership between more than 300citiesand municipalities, the International Association of Providers of AIDS Care (IAPAC), the Joint United Nations Programme on HIV/AIDS (UNAIDS), and the United Nations Human Settlements Programme (UN-Habitat), and the City of Paris. The initiative was launched on World AIDS Day 2014 in Paris. For more information please visit: www.iapac.org/fast-track-cities.

The Fast-Track Cities Quality of Life Survey was developed by IAPAC, in partnership with the Joint United Nations Programme on HIV/AIDS (UNAIDS), the Global Network for People living with HIV (GNP+) and the International Community of Women Living with HIV (ICW). The survey was funded through a grant provided by ViiV Healthcare and conducted in 15 cities, across sub-Saharan Africa (Bamako, Dar Es Salaam, Durban, Nairobi); Asia (Bangkok); Europe (Athens, Berlin, Lisbon, Madrid); Latin America (Buenos Aires, Salvador de Bahia, Santiago); and North America (Miami, Montréal, New York City). As designated Fast-Track Cities, all 15 Fast-Track Cities have formally committed to scaling-up their local AIDS responses to end their HIV epidemics by 2030.

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