Anja Glover | November 2023

In recent decades, medicine has made significant progress in the treatment of people living with HIV. However, there has been little progress in society when it comes to discrimination against people living with HIV. For example, those affected repeatedly talk about the microaggressions they are faced with. These are subtle, often unconscious actions or comments that express prejudice and negative stereotypes based on factors such as gender, racialisation, sexual orientation, faith or other factors such as illness. They are often trivialised because an individual microaggression is seen by the perpetrator as unconscious, "well-intentioned" or "not that bad". This ignores the extent to which they have profound and hurtful consequences for those affected. Microaggressions behave in a similar way to snowflakes on a tree branch: the individual pain may be bearable, but their repeated appearance leads to too much stress, so that at some point they are no longer bearable. Just like a tree branch with a lot of snow on it: over time, it becomes weaker and weaker until it finally breaks.

Insensitive questions and stereotypical ideas

Microaggressions against people living with HIV can occur in all areas of life and manifest themselves in various forms. They are often difficult to identify as they hide behind supposedly harmless questions, statements or actions. One of the most common is stigmatisation through insensitive questions such as "How did you get infected?" or "Did you inherit it from your mother?". Such questions suggest that HIV infection must be the result of risky behaviour or familial transmission, rather than accepting HIV as a possible disease that can affect anyone.

Another form of microaggression is unsolicited advice or judgement about the behaviour or lifestyle of people living with HIV. Or when people living with HIV are pitied or treated differently to people without HIV. Obviously derogatory remarks are also part of microaggressions. In addition, people may avoid physical contact with people living with HIV for fear of infection. Microaggressions reduce those affected to their illness, as if this constituted their identity. Their interests and characteristics are ignored. Microaggressions lead to those affected feeling marginalised and isolated. At the same time, they contribute to the stigmatisation of people living with HIV and prevent them from being able to talk openly about their health.

Serious health consequences

As the name suggests, microaggressions may seem small, but over time they can have a detrimental impact on a person's experience, physical health and mental wellbeing. Research suggests that these subtle forms of interpersonal discrimination are at least as harmful as more overt forms of discrimination. Microaggressions are therefore not just "unpleasant moments" in the lives of those affected. Nor do they occur infrequently; rather, they are rarely recognised. And although they may seem unconscious or inconspicuous, they can have serious health consequences for those affected. Microaggressions are particularly traumatising when they occur in places or situations where they are not expected, such as in healthcare settings where they are supposed to be helped and protected. Studies have shown that people living with HIV are often treated poorly by medical staff, which can make them feel unsafe and misunderstood when they seek medical help.