The world continues to grapple with stigma and discrimination – key barriers to effective response to the AIDS epidemic. Yesterday, UNAIDS presented its conceptual framework for addressing HIV/AIDS related stigma and discrimination. This framework (a UNAIDS Best Practice document available in Spanish, English and French) aims to offer an action plan for the World AIDS Campaign 2002-2003.

According to Peter Aggelton, one of the authors of the UNAIDS document, the non-negotiables offered by the framework are as follows:

• Prevent HIV/AIDS stigma from forming

• Challenge stigma and discrimination where they arise

• Redress human rights violations

Aggelton and Parker say that stigma is a process of identifying undesirable differences, often resulting in personal and societal denial. The authors also state that stigma plays into, reinforces and reproduces the many systemic inequalities that exist in societies in every part of the world – inequalities based on sexual, racial, class and gender divisions.

The UNAIDS document is an excellent academic compendium of the various theories and experiences of stigma and discrimination. But it fails to address the crucial synergy between treatment and prevention and the systemic inequities that fuel the spread of the epidemic. This is a particularly surprising omission in the light of the letter by Peter Piot (UNAIDS), Debrework Zwedie (World Bank) and Tomris Tormen (WHO) which was published in the Lancet (6 July), which clearly acknowledges and supports the critical link between the availability and accessibility of treatment and its impact on reducing stigma and discrimination.

Though the document presents various examples of how stigma and discrimination can be addressed, it fails miserably in terms of delivering the goods that its title suggests: a framework for action in mitigating stigma and discrimination. Yet again UNAIDS appears to be mired in rhetoric.

AIDS 2002 Conference News produced by Health & Development Networks/Key Correspondent Team