A groundbreaking study from Zambia offers critical lessons for health systems seeking to improve HIV prevention outcomes. Researchers identified three overlapping forms of stigma—chronic discrimination (28.2%), PrEP-specific stigma (22.5%), and HIV-related stigma (20.2%)—that collectively undermine medication adherence among sex workers. The key takeaway: addressing occupational stigma is essential to preventing early medication discontinuation. Women experiencing high chronic discrimination had a 65% increased risk of stopping PrEP within three months, despite facing 21-fold higher HIV acquisition risk than the general population. For health providers and policymakers, this means anti-stigma interventions are not optional add-ons but core components of HIV prevention programs. Creating safe, non-judgmental clinical environments and addressing societal discrimination against sex workers are prerequisites for effective biomedical prevention. The study demonstrates that without addressing structural barriers alongside medication provision, prevention tools cannot reach their full protective potential.
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