HIV and Stigma in the Health Professions: only 34% master concepts such as PrEP, EPP and i=i

Despite scientific advances in HIV treatment and prevention, stigma and discrimination continue to be significant barriers to accessing healthcare for people living with HIV (PLHIV). A recent study, with the participation of GAT, revealed worrying data on the knowledge and attitudes of health professionals in Portugal.

In 2013 and 2022, the HIV and AIDS Anti-Discrimination Center (CAD), coordinated by GAT and SER+, launched the Stigma Index study, which warned of discrimination by health professionals. In 2013, 79 people living with HIV said they had been turned away from health services because of their HIV status, while the Stigma Index 2.0 indicated an increase of almost 80% in the breach of confidentiality of HIV status in health services.

Main results of the study

The study promoted by a team of health professionals and researchers, conducted between September and December 2023, involved 807 health professionals from various fields, including medical professionals, nurses and clinical and non-clinical professionals. In terms of work context, professionals working in hospitals, health centers and community care units took part, with the aim of providing a comprehensive overview of the different levels of healthcare provision in Portugal.

Only 1 in 3 professionals has a good knowledge of HIV prevention and treatment

Only 34% of professionals demonstrated a high level of knowledge about i=i, the effectiveness of PrEP and PEP:

• i=i stands for “Undetectable equals Untransmittable”, referring to the scientific fact that people living with HIV who maintain an Undetectable viral load with treatment do not transmit the virus to sexual partners;
• PrEP (Pre-Exposure Prophylaxis) is a drug that effectively prevents HIV infection and can be used alone or in combination with other prevention methods;
• PEP (Post-Exposure Prophylaxis) is a treatment started up to 72 hours after exposure to HIV to prevent infection.
• The study found that professionals over the age of 40, non-medical professionals and female respondents were less likely to have in-depth knowledge of these concepts.

Stigma still present in healthcare

Although the majority of professionals do not reveal openly discriminatory attitudes, 22% agreed with at least one stigmatizing statement about PLHIV. In addition, 31% of professionals reported having observed discriminatory attitudes in their institutions in the last year, including:

• Refusal of care to PLHIV (31%);
• Discriminatory comments (28%);
• Breach of confidentiality about HIV status (27%);
• Provision of poorer quality care (22%).

GAT Checkpoint LX, community-based screening center for HIV and other Sexually Transmitted Infections (STIs)

Hospitals were identified as the contexts with the highest prevalence of institutional stigma, while community centers, such as GAT's, revealed more inclusive environments.

Why are these results worrying?

Stigma and lack of knowledge directly affect the quality of health care provided, as well as imposing barriers of stigma and discrimination that hinder access to health services in a dignified, safe and humane way. These results highlight the urgent need to:

Strengthen HIV training and reduce stigma

Only 32% of participants reported having received specific training in HIV-related stigma and discrimination. The study showed that professionals with more training were less likely to display stigmatizing attitudes.

Implement institutional #ZeroStigma policies

Healthcare institutions must adopt clear policies and effective, anonymous reporting mechanisms to combat discriminatory practices. The CAD Complaint and/or Report Form is an example mechanism for collecting complaints of discrimination.

Promote knowledge about key concepts such as i=i, PrEP and EPP

Understanding these concepts is key to reducing fear and discriminatory attitudes based on misinformation. In addition, PrEP, PEP and i=i are crucial for health literacy and sexual prevention to be more effective and adapted to all people, so low knowledge also impacts HIV prevention strategies.

How does GAT contribute to change?

GAT is committed to promoting health environments that are inclusive and free from discrimination. This study reinforces the importance of continuing to invest, with a focus on public health bodies and education, in three areas in order to achieve Zero Discrimination:

Training sessions for health professionals

The HIV and Aids Anti-Discrimination Center (CAD), of which GAT is a part, promotes training on HIV for:

• health, medical and nursing professionals, with the most up-to-date and scientifically proven knowledge about HIV infection, so that they can apply the most appropriate practices from an ethical and scientific point of view when carrying out their professional activity;
• teachers in the area of respect, equality and non-discrimination, especially on issues related to sexuality (sexual orientation, gender identity and equality, dating violence, promotion of healthy behaviors), enabling teachers to work on these issues with students in the classroom (12-hour face-to-face training course, accredited by the Scientific Council for Continuing Teacher Education).

GAT regularly promotes internal training in these areas to ensure that people living with HIV are safe with the care of the peers who work in our services.

Awareness campaigns on the rights of people living with HIV

Since 2022, GAT and SER+ have launched two campaigns to eliminate HIV stigma (I Am HIV+ Campaign and Visible) and increase knowledge of the scientific evidence Undetectable = Untransmissible (Transmissible Campaign), with the support of the Directorate-General for Health and the pharmaceutical companies Gilead, MSD and ViiV. Sharing the same vision, GAT promotes knowledge about the rights of PLHIV through campaigns and publications disseminated nationally and internationally.

Advocacy for public policies that fight stigma at all levels of society

The advocacy promoted by GAT activists is focused on the promotion of health, rights, participation, non-discrimination and the defense of easy, equitable and adapted access to effective STI prevention services, such as:

• Free vaccination against the Herpes Zoster;
• Updating the National Vaccination Plan for PLHIV;
• National strategic leadership for the HIV pandemic in close collaboration with civil society;
• Defending the anonymity of people diagnosed with an STI;

The activism developed by CAD has contributed to, among other things, banning discrimination on the grounds of aggravated health risk, ensuring access to life insurance and eliminating discrimination against PLHIV in municipal swimming pools and in access to military service.

If, like GAT, you believe that these three axes promote change, get involved with us so that we can build a fairer and truly inclusive health system, where all people are treated with dignity and respect. Join us!

_{Sources:
Cota Medeiros F, et al. Knowledge and HIV-related stigma among Portuguese healthcare professionals: A cross-sectional analysis. HIV Med. 2025;1-12. doi:10.1111/hiv.70039. Available at gatportugal.org/public/uploads/noticias/HIV_Medicine___2025___Cota_Medeiros___Knowledge_and_HIV___related_stigma_among_Portuguese_healthcare_professionals.pdf
SER+, GAT, ENSP-NOVA, Directorate-General for Health. Stigma Index Portugal 2022: Final Report. Cascais: SER+; 2022. ISBN: 978-989-98611-4-5. Available at: cad.vih.pt/areas-de-atuacao/investigacao
SER+, GNP+, GAT. Evaluation of the PVL Stigma Index in Portugal. Lisbon: SER+; 2014. ISBN: 978-989-98611-0-7. Available at cad.vih.pt/areas-de-atuacao/investigacao}