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Arachu Castro, PhD, MPH and Paul Farmer, MD, PhD

The authors are with the Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School; Partners In Health; and the Division of Social Medicine and Health Inequalities, Department of Medicine, Brigham and Women’s Hospital, Boston, Mass.

Correspondence: Requests for reprints should be sent to Arachu Castro, PhD, MPH, Program in Infectious Disease and Social Change, Department of Social Medicine, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115 (e-mail: arachu_castro{at}hms.harvard.edu).

For the past several years, diverse and often confused concepts of stigma have been invoked in discussions on AIDS. Many have argued compellingly that AIDS-related stigma acts as a barrier to voluntary counseling and testing. Less compelling are observations regarding the source of stigma or its role in decreasing interest in HIV care.

We reviewed these claims as well as literature from anthropology, sociology, and public health. Preliminary data from research in rural Haiti suggest that the introduction of quality HIV care can lead to a rapid reduction in stigma, with resulting increased uptake of testing. Rather than stigma, logistic and economic barriers determine who will access such services. Implications for scale-up of integrated AIDS prevention and care are explored.

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