Stigma, scale-up, and treatment governance: stumbling block or window of opportunity?

This paper from the POLICY Project examines the problems and opportunities associated with the current expansion of access to anti-retroviral therapy (ART) for people living with HIV. The paper outlines a treatment governance approach to the development of ART services and draws on research from Vietnam to illustrate the importance of encouraging the participation of those living with HIV in the development of treatment policies. Treatment governance stresses the importance of monitoring and managing the impact of ART. This means strengthening comprehensive treatment monitoring, encouraging multisectoral collaboration and using an interdisciplinary approach to the management of treatment services.

The expansion of access to ART services creates particular challenges and opportunities concerning anti-HIV stigma and discrimination. There is no evidence that the wider availability of ARV automatically lessens anti-HIV stigma, and there is in fact an increased potential for people to be stigmatised and discriminated against since accessing treatment involves disclosing one’s status. However, the shift from HIV being a fatal to a chronic illness, and the ability of people with HIV to continue working and maintain other social activities, should decrease the levels of stigma. But the potential for increased access to treatment to effect these changes in stigma depends on the effectiveness of the treatment governance, and in particular such factors as the quality of the service and the integration of HIV positive people into the process of developing and managing the service.