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Throughout the course of human history, there have been few health conditions more mired in socializing stigma than HIV/AIDS. Despite transformative advances in medicine that have given renewed hope to millions of HIV/AIDS patients around the world, deep-seated public perceptions and stigma associated with the condition have been slower to evolve. As it were, Afghanistan is no stranger to the adverse effects of public stigma surrounding HIV/AIDS. So long as comprehensive, education-based approaches for stigma reduction are not systematically implemented nationwide, present efforts to combat the spread of the virus will see diminished effectiveness and sustainability.

Globally, much of the contemporary HIV-related stigma is rooted in the misinformation perpetuated across the decades since the origins of the epidemic. Initially, public hysteria in the face of sparse and unverified information about the spread of the virus bred discrimination-laden public practices and policies. While these practices largely masqueraded as precautionary attempts to curtail infection rates, their continuing legacy has been an ingrained set of biases and stigmatizing attitudes regarding HIV, HIV modes of transmission, and HIV patients. The tangible impact of this stigmatization was most aptly summarized by a patient living with HIV whom I once spoke with, who poignantly noted, “When you tell people that you have HIV, they feel like they can automatically assume something about you and your history.”

The harm of HIV-related stigma extends beyond interpersonal injury. When individuals are shamed out of initiating conversations with healthcare providers or shamed into withholding critical behavioral and health information from healthcare providers, they are likely to miss out on learning about options for HIV/STD testing. Without knowing their HIV status, afflicted individuals will lose valuable time to pursue a treatment course, the ultimate effects of which put a strain on the entire health system. Even the Joint United Nations Programme on HIV and AIDS highlighted this problem when the body issued a report describing stigma reduction as an indispensable component of the global fight against AIDS (“Confronting discrimination: overcoming HIV-related stigma and discrimination in health-care settings and beyond,” 2017).

Another key effect of HIV-related stigma is its implications for hindering accurate data collection on HIV infection rates. In Afghanistan, the size of the population of HIV-positive patients has been debated, with notable differences in the incidence rates provided by Afghanistan’s Ministry of Public Health and the World Health Organization. What is clearer is that the figures probably represent an underreporting of the issue, since afflicted individuals may be less likely to actively seek out treatment for fear of being subject to harassment and discrimination based on their status. This deleterious silencing effect is pronounced for the most vulnerable populations, including women and children, for whom rates of infection have risen in tandem with spikes in drug usage and needle sharing.

Given the manifest and system-wide harms of HIV-related stigma, particularly in the Afghan context, it is clear that stigma reduction interventions must take hold in a timely fashion. History has shown repeatedly that attitudinal changes are not a natural outcome of passing time but instead require deliberate, programmatic action. An education-based approach that challenges widely ingrained, myth-based biases and includes up-to-date information about prevention and testing options would seem to be an effective first step. Coordination among the Ministry of Public Health and the Ministry of Education to integrate this type of educational intervention into school curricula could have a promising impact in terms of increasing individuals’ self-efficacy in managing their own health.