The most profound ethical problem that arises in the field of HIV is stigma and its repercussions, and it therefore warrants addressing first. 

The word stigma comes from the Greek word meaning a mark of disgrace or shame (9).
Stigmatisation can lead to discrimination resulting in unequal or unjust outcomes (10). 

HIV-related stigma is defined by the Joint United Nations Programme on HIV/AIDS (UNAIDS) as ‘negative beliefs, feelings and attitudes toward people living with HIV, groups associated with PLHIV and other key populations at higher risk of HIV’ (11). 

HIV-related discrimination has been defined as:  

Unfavourable treatment on the basis of known or imputed HIV status; action or inaction that results in people being denied full or partial access to otherwise generally available services or opportunities because of known or imputed HIV status (12). 

Discrimination can be further described as direct and active (intentional and planned) – such as the placing of alerts on an HIV-positive person’s clinical file or refusing to treat or care for a person with HIV.  Alternatively, discrimination may be indirect and passive – such as the establishment of rules, policies, or conditions that in themselves do not appear discriminatory but result in discrimination against those who are unable to meet the required conditions (13). For example, generic intake practices where a person is asked about their diagnosis over the phone can indirectly discriminate by reducing access for people with HIV who are reluctant to disclose their HIV diagnosis to strangers and who may, therefore, avoid contacting a service.  

Internationally and within Australia, numerous studies have found that people with HIV experience discrimination by nurses and other health workers, ranging from prejudicial attitudes, lack of eye contact, brusque speech, the use of excessive infection control precautions or inconsistencies around the use of standard precautions, denial of care, modifying care (for example, not taking blood, not touching patients) (14). 

Women with HIV who are pregnant or trying to become pregnant have been judged more harshly than others and have been frequently labelled drug users or sex workers, with assumptions being made about their lives (14). In some countries, women living with HIV have been forcibly sterilised or coerced to terminate their pregnancy and undergo other coercive reproductive practices in health care (15, 16). Human rights abuses such as these derive from entrenched HIV-related stigma. 

The 2022 Australian HIV Futures Survey indicated that more than one-third (36.6%) of the respondents living with HIV reported at least one experience of HIV-related stigma or discrimination in the past 12 months. 29.8% of those surveyed reported they had been treated differently by a healthcare worker due to their HIV in the past 12 months (17). Common forms of stigma and discrimination include avoidance, confidentiality breaches, and the use of excessive infection control measures.  

Experiences of stigma and discrimination against PLHIV are common within health settings; thus, the care and treatment of people living with HIV remains an important area of concern for nursing and midwifery ethics.