Tracing Structural Stigma in Health Care Towards People With Blood Borne Viruses and Sexually Transmissible Infections: Stigma Power, Societal Norms and Hidden Processes

Background Analysis of power is often omitted from research on stigma. This project examined structural stigma and power in health care for people affected by blood-borne viruses and sexually transmissible infections (BBV/STIs) with a focus on societal norms and hidden assumptions that shape health care practice and policy. Method In-depth interviews were conducted in 2023 with 24 key informants with expertise in designing and delivering services for people with BBV/STIs. Analysis examined stigma embedded in techniques of governing people affected by BBV/STIs. Results Participants noted the ways in which societal norms produce health systems, infrastructure, practices, and attitudes that work to keep people affected by BBV/STIs excluded from or receiving sub-optimal care. Stigma associated with BBV/STIs was tainted by moralism and perceived disgust in societal norms surrounding these conditions and associated practices. Participants noted that these norms supported “taken for granted” policies or procedures that worked to exclude people or protect the health system from complaint or change. Suggestions of means to address the impacts of these norms on health systems and dismantle stigma power included strengthened complaint systems and involvement of people with lived/living experience in decision-making and service delivery roles. Conclusion There are reciprocal and mutually productive relationships between societal norms and health care systems. Disrupting these relationships needs specific intervention given the foundational influence of societal norms and porosity between social worlds and health systems. Looking upward to governance systems already in place might be one tool to bring to light and reshape stigma power relations in health systems.