11 December 2024
Stigma. For those of us working with people who use drugs, it’s a word we hear every single day. Stigma, judgement, and discrimination—these often unseen yet unbelievably damaging barriers stop people from accessing the healthcare and support they need.
The inaugural Tackling Stigma Conference in Sydney, Australia, in November was a deep dive into stigma in all its forms: drug use, gender, race, religion, disability, HIV, LGBTQI+, sex work, abortion, and even areas that might not immediately come to mind—like obesity or diabetes. One statistic mentioned during the plenary revealed there are over 90 stigmatised identities, health conditions, and personal attributes, though the real number is likely much higher.
This staggering breadth of stigma was a stark reminder of just how deeply ingrained it is in our society. Combating stigma is not just about improving healthcare access—it’s about making sure people can lead their lives with dignity and respect.
Read on for our key takeaways from the event.
Shifting the Focus to Structural Stigma
When we think about stigma, our minds often go straight to those one-on-one interactions: the doctor who makes a patient feel small and unworthy or the prison officers who treat withdrawal as anything other than a major health concern.
These moments are personal and painful, but as Professor Kate Seear, Deputy Director of the Australian Research Centre in Sex, Health and Society at La Trobe University, reminded us, the impact of systemic stigma can be even more devastating.
Seear shared the tragic story of a young Indigenous woman who died in custody in Australia in January 2020. The inquest revealed that stigma and dehumanising treatment directly contributed to her death—a tragic case that not only highlighted a failing in compassion but also a violation of human rights laws.
If ever there were an example of stigma’s devastating consequences, this was it. It is hoped that the case can go on to be used as a precedent for change and accountability in the future. But it also raised an important question: What can meaningful change actually look like?
Embedding Anti-Stigma Practices
One overarching message from the conference was clear: stigma must be tackled at a structural level. The organisations and governments that are supposed to protect us need to lead the charge, embedding anti-stigma practices into their systems and making sure they’re upheld.
As Michelle Blanchard, Co-Chair of the Global Anti-Stigma Alliance, put it: “We need sustained actions to change cultures and systems—and then hold people accountable. It’s not just a shiny new initiative or project.”
It was even argued that “stigma” is a softened term for prejudice, one that lets people and institutions sidestep responsibility for behaviours that can sometimes be outright illegal.
Ideas on how to achieve structural change were woven throughout the conference: adding anti-stigma guidelines to organisational codes of conduct, with real repercussions if they’re not followed, and integrating these principles into recruitment processes and performance reviews.
Introducing The Stigma-Free Standard
One of the most inspiring ideas for me was The Stigma-Free Standard, introduced by Scientia Professor Carla Treloar from the Centre for Social Research in Health at UNSW Sydney. Treloar asked a question that resonated with the audience:
“Why are we trying to educate people about individual types of stigma, when we could develop a universal standard to address them all?”
And honestly, it makes so much sense. Healthcare workers are already stretched thin, with limited time and resources. Asking them to undertake separate training for every type of stigma just isn’t feasible. As one speaker bluntly put it:
“No one will invest in HIV stigma training when there are only 29,000 people with HIV in Australia.”
Instead, Treloar and her team have developed a single, unified framework to address all forms of stigma. Set to be trialled across four health departments in New South Wales in 2025, this standard could have enormous global potential if successful.
The concept of intersectionality—how different stigmas overlap and amplify one another—was a recurring theme throughout the two days. The Stigma-Free Standard offers a practical way to address this complexity, and the hope is that its impact won’t just be limited to healthcare but will ripple out into other areas where prejudice has harmful consequences.
Using Complaints to Shine a Light on Stigma
Another intervention that stood out was the idea of using complaints to identify and address stigma. It’s simple yet powerful: complaints can reveal where stigma exists and provide practical insights to guide change.
Emily Lenton, Research and Project Officer also from the Australian Research Centre in Sex, Health and Society at La Trobe University, explained that while complaints have the potential to highlight stigma, many people avoid filing them. Fear of further judgement, coupled with overwhelming bureaucracy and red tape, creates a vicious cycle.
“Complaints can reveal where stigma is occurring, but many stigmatised people avoid filing them due to fear of further stigma,” Lenton noted.
Fixing this broken system is crucial. Removing the barriers to lodging complaints could pave the way for more equitable policies and better support systems, transforming a daunting process into a tool for change.
Language Is Just the Beginning
Caty Simon from the North Carolina Survivors Union made a point that will stick with me for a long time: “Language matters, but word choice is not enough.”
While inclusive language is essential, it’s often seen as an easy way to “check the box” of addressing stigma. The reality is that stigma is far too entrenched to be solved by simply swapping out words. It takes much more work—and commitment.
She shared insights from the Narcofeminism StoryShare project, which uses storytelling to dismantle structural and self-stigma. A stand out exercise from their workshop was “Anonymous Biases,” where participants share their stories of bias anonymously, sparking honest, meaningful discussions and helping uncover biases and judgements you might not even realise you hold.
We also shared one of our storytelling projects at the conference – Storytelling for Advocacy, South Africa and Kenya – a mentor program that skills up people who use drugs to share their stories for change. You can read more about the program here.
Centring Peer Voices in Everything
Finally, and perhaps most importantly, every intervention discussed at the conference reinforced this critical point: the voices of stigmatised communities must be front and centre. Every panel, every presentation, rightfully pushed this forward.
Professor Treloar opened the conference with a powerful definition of stigma as something designed to “keep people down, in, or away.” It only exists when someone holds power over another.
To dismantle stigma, we urgently need to elevate those affected into positions of power. The incredible interventions and ideas presented over these two packed days were a rallying cry for change.
For a conference on a topic that had the potential to weigh us down, we walked away feeling hopeful. We can—and we will—fight stigma at its root.
