A woman living with HIV shows up to her community clinic for antenatal care. The nurses ask why she got pregnant. 

A man living with HIV goes to his dental appointment. He arrives first, but the staff treat him last. 

A young transgender woman learns she is HIV positive. She was already scared about how she would be treated. Now she’s doubly terrified. 

A man living with HIV is hopeful when he applies to a new job. He’s dismayed when they demand an HIV test.

The Thailand Stigma Index 2.0 study was launched in early March to commemorate Zero Discrimination Day. It shows that despite a strong national HIV response, challenges continue to simmer below the surface. 

Sixteen percent of participants reported discrimination in healthcare settings in the past year. Among women, almost one in ten experienced prejudice while accessing health services, including coercion about contraception. Internalized stigma was common, with 39% of participants feeling ashamed of their HIV status. Self-stigma was especially high among key populations and younger people. And 3% of participants reported that they experienced a human rights violation in the past 12 months. 

When compared to the 2009-2010 Stigma Index there has been progress. In that study 20% of participants were denied health services and the same proportion reported discriminatory reactions from health service providers after learning their HIV status. Shockingly, in the 2009-2010 report almost half of respondents (47%) said they experienced violations linked to their HIV status in the last year. 

“For each individual living with HIV who has experienced stigma or discrimination the effects can be long-lasting. Therefore, even the findings that have been experienced by only a few individuals in the new study are of concern,” said UNAIDS Country Director for Thailand, Patchara Benjarattanaporn. “We are serious about the goal of zero discrimination.” 

This was a Stigma Index with a difference. The Task Force ensured all groups were represented including women, young people and key populations. People living with HIV in all the provincial networks were trained to conduct the study. And they added qualitative and gender components to the methodology to deepen the analysis. The study reflects the experiences of more than 2500 respondents across 24 provinces between 2022 and 2023. 

“Addressing stigma and discrimination is key to ending AIDS. At the national and local level there are still issues to be dealt with. Stigma and discrimination lead to people not getting tested, not accessing care and not adhering to treatment,” said Nipakorn Nanta, Chairman of the Thai Women Living with HIV Foundation (TWLHF).

TWLHF led the research exercise, working to ensure the experiences of women were well reflected for the first time. Ms Nanta noted that although Thailand has eliminated mother to child HIV transmission, the emphasis seems entirely on preventing infections in babies. Sometimes women’s agency and confidentiality are sacrificed. 

Mr Sattayu Sithirakarn, Director of the CareMat Foundation noted that young men who have sex with men often have a difficult time handling the double stigma of HIV and their sexual orientation.

“The report lays out the issues around internalized stigma very clearly. It is important because if people living with HIV do not have hope, they don’t have the motivation to take care of themselves and have a future,” he said. 

The Task Force youth focal point, Pete Thitiwatt Sirasejtakorn, shared that this was something he had to overcome. 

“When I was diagnosed, my life went in a very bad direction,” he said. “At age 25 I left my two businesses. I thought I would die soon. It was unacceptable to me to die from an AIDS-related illness. I thought it was better to kill myself before I got sick. My boyfriend got tested and he was HIV-negative, but he still stayed with me. He empowered me and encouraged me to keep going. But I broke up with him because I had very high internal stigma. I felt dirty. I felt dangerous.” 

The game-changer for Mr Sirasejtakorn was knowing about U=U—undetectable equals untransmittable. This refers to the scientific fact that people living with HIV who lower the virus in their blood to an undetectable level through consistent treatment have zero chance of infecting someone they have sex with. 

This is one of the main strategies the report recommends for addressing both self- and social stigma. The report also calls for improved public communication, family and social engagement, enhanced healthcare workforce training, and a focus on human rights in laws and policies for key populations. 

Some of this work is already underway. In December 2024, Thailand hosted a mission to review ten years of efforts to reduce HIV-related stigma and discrimination in healthcare settings. The review found that although 400 hospitals have participated in stigma reduction training, policies must be properly implemented at the provincial and district levels. 

Dr Phongthorn Chanleuan, Chairman of the National Stigma Index Task Force also stressed the importance of community leadership. 

“We need strong networks of not only people living with HIV but also youth, women, and LGBT people working together to address stigma and discrimination as a cross-cutting issue,” he said.