Almost everything in this issue seems to have something to do with the subtle and not-so-subtle workings of HIV-related stigma.

Stigma, as Michael Ratsey says in his piece Stigma begins at home,, is not discrimination. Discrimination is to do with how people are treated. It can therefore be dealt with, in a favourable climate, by equality legislation. The UK has been a leader in this field, being one of the first countries to include HIV infection (and not just HIV-related illness) in its Disability Discrimination Act.

Stigma, on the other hand, is about how people are viewed. Stigmatised people are viewed as if they were different and inferior, just because they have one or more characteristics not regarded as ‘normal’.

Stigma is difficult to prove, and more difficult to legislate for: you can’t order someone not to have prejudices. What you can do is combat the ignorance and misconceptions that cause those views. Sometimes this may simply involve giving people the facts. Press Gang, for instance, is a growing initiative of the National AIDS Trust which alerts members to stigmatising stories in the press so that they can reply with comments.

Sometimes it may require acts of extraordinary courage. HTU Readers’ Panel member Annmarie Byrne says:

“I have always spoken out about living with HIV.  I have had 'AIDS' graffiti painted on to my home and my son was surrounded by youths who shoved him and told him his mother was a diseased old c***… I have been asked why I don't just keep quiet, but when it comes to trying to educate people, I feel I can't keep quiet!”

That’s in the UK. In parts of the developing world there are worrying signs that access to treatment may be having the side-effect of making stigma worse. In the last month the Zambian Health Minister suggested that people with HIV be given “sex depressants to quench their insatiable sexual appetite” and a Swazi MP suggested that people diagnosed with HIV should be branded on the buttocks. There are signs of a growing culture of blame against people with HIV in southern Africa. And the utterly disproportionate 25-year sentence in Iowa against a man who had sex once (with a condom, but without disclosing) with someone he didn’t infect, reminds us that it is not just in Africa that people with HIV seem to be demonised for having sex at all.

But that’s not the worst aspect of stigma-based views. The worst is that they get under people’s skin and they start believing them themselves. They might ‘keep quiet’ and deprive themselves of the chance to express themselves, or the opposite happens: people get ‘chippy’, ready to take offence at innocent remarks.

In the case of dentists, as we discover in Whose fear is it anyway?, there are some old-fashioned views about HIV still circulating in the profession. But in researching the story it was sometimes difficult to tell what was prejudice or a candid confession of ignorance by a healthcare professional who probably knew less about HIV than their patient. If we shout “oppressor” at everyone who comes to us with misinformation or a stereotype, we may be missing the chance to educate them.

It may be easier said than done, but sometimes the only response to stigma is to refuse to be stigmatised.