Stigma profoundly affects the lives of people with HIV/AIDS. Fear of being identified as having HIV or AIDS may discourage a person from getting tested, from accessing medical services and medications, and from disclosing their HIV status to family and friends. In the present study, we use focus groups to identify the most salient domains of stigma and the coping strategies that may be common to a group of diverse, low-income women and men living with HIV in Los Angeles, CA (n = 48). We also explore the impact of stigma on health and healthcare among HIV positive persons in our sample. Results indicate that the most salient domains of stigma include: blame and stereotypes of HIV, fear of contagion, disclosure of a stigmatized role, and renegotiating social contracts. We use the analysis to develop a framework where stigma is viewed as a social process composed of the struggle for both internal change (self-acceptance) and reintegration into the community. We discuss implications of HIV-related stigma for the mental and physical health of HIV-positive women and men and suggestions for possible interventions to address stigma in the healthcare setting.

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These conferences have been prompted by a lag in knowledge about HIV disease in women. Not only has clinical research historically been conducted principally with male study subjects (not until 1985 did the National Institutes of Health (NIH) urge the inclusion of women in clinical trials) but, in the U.S., men have accounted for the vast majority of cases of AIDS since the beginning of the epidemic. The progression and clinical manifestations of HIV disease were therefore first described as they occurred in men, and AIDS-defining conditions were first selected on the basis of observations made in men. Not until 1993 were certain manifestations of AIDS particular to women also made AIDS-defining conditions by the CDC. Men were more readily enrolled in clinical trials. As a result, the metabolism and toxicities of new drugs were determined largely in men. To date, it is often not known with certainty whether drug safety and metabolic data are fully applicable to women.Over time, the proportion of women with AIDS has increased steadily in the U.S. Although women accounted for only 7% of the cases of AIDS reported in 1985, they constituted 20% of the 13,830 new cases reported in 1996. From the beginning of the epidemic through December 1996, 85,500 women have been reported with AIDS. Today, an estimated 120,000 to 160,000 women are infected with HIV in this country. There are differences, between men and women, in the manifestation and the complications of HIV disease. Some such differences are due to biological factors, others are due to socioeconomic and cultural factors.Among biological differences unique to women are infections and malignancies of the female reproductive tract. Although they also occur in women without HIV infection, these pathologies are more aggressive and more difficult to treat in HIV-infected women. They are genital ulcers of unknown origin; vaginal candidiasis; bacterial vaginosis; pelvic inflammatory disease (PID); papilloma virus infections; cervical intraepithelial neoplasia (CIN), and cervical cancer (an AIDS-defining condition since 1993); menstrual disorders, and premature menopause. Also unique to women with HIV are issues raised by pregnancy and risk of HIV transmission to newborns (since 1994, maternal infant transmission is largely preventable through antiretroviral treatment of the mother during pregnancy and of the infant during the first 6 weeks of life). There are, perhaps, also differences in drug metabolism and toxicities due to the female hormonal status. More studies are needed in all these areas.One of the few studies, published in the Journal of the American Medical Association in December 1994, that compared survival and disease progression in many women and men found that while HIV disease progression oc-367