3In the wake of the fear and uncertainty that emerge during a pandemic, stigma and discrimination quickly follow, exposing people to violence, harassment and isolation, and hampering the delivery and uptake of essential health services and public health measures to control the pandemic.
The stigma that arises during a pandemic can exacerbate existing inequalities, including those related to race, socioeconomic status, occupation, gender, immigration status and sexual orientation. The presence of stigma specific to certain health conditions has been observed in the HIV pandemic, the outbreaks of Ebola virus and Zika virus, and now the COVID-19 pandemic. The anticipation of stigma during a pandemic can interfere with the adoption of preventive measures, timely testing and adherence to treatment.
Many forms of stigma and discrimination have surfaced since the identification of COVID-19. Xenophobia has been directed at people thought to be responsible for “bringing” COVID-19 into countries. People who have recovered from COVID-19, essential workers such as health-care staff, and populations facing pre-existing stigma and discrimination (e.g. people living with HIV, people from gender and sexual minorities, sex workers, migrants) have been subject to verbal and physical abuse.
In several countries, people living with HIV report being required to disclose their HIV status when seeking HIV services during lockdowns, especially adolescents, women and transgender people. Increases in violence have been reported among women and people from gender and sexual minorities as a result of stay-at-home orders and physical distancing measures. Attacks on lesbian, gay, bisexual and transgender youth under the guise of public health enforcement measures, and lack of social protection and income security for sex workers, have been documented.
Efforts to eliminate both existing and COVID-19-related stigma and discrimination are urgently needed and should be an integral component of global efforts to respond to the pandemic. Particular attention is needed to ensure people from vulnerable populations, including racial and gender minorities, are protected during the response and are not further marginalized, as emerging evidence suggests these populations are experiencing high morbidity and mortality related to COVID-19.
Engagement and participation of all sectors of the community in the development of context-specific public health responses to COVID-19 are paramount. Networks of people living with HIV, key populations and women’s groups have three decades of experience of implementing stigma-reduction programmes in the context of HIV, which countries can tap into to inform and support community-based public health responses to COVID-19.