HIV/AIDS stigma: an impediment to public health.

Stigma is not new to public health, nor is it unique to HIV/AIDS. History provides an unfortunate abundance of examples of “prejudice, discounting, discrediting, and discrimination”1 directed toward persons who are ill or perceived to be ill. Leprosy was viewed as divine punishment for moral misconduct in centuries past, and persons infected with Mycobacterium leprae were forcibly excluded from both civil and religious society.2 Those who became ill with cholera in the early years of our American republic were publicly decried as intemperate, lazy, and vice ridden.3 Even after the germ theory became widely accepted, discrediting divine wrath, miasma, and other incorrect theories of disease, negative attitudes lingered. For example, some persons with syphilis were “innocent”; others were not. Often, physicians were reluctant to treat patients in the latter category, considering them immoral and hence unworthy of care.4