The damage of stigma and discrimination goes beyond HIV. The deeper point is that discrimination becomes embodied harm.
No one enters this world vulnerable. Vulnerability is constructed. It is the product of systems that exclude, policies that criminalise and societies that look away.
Zero Discrimination Day is a moment of reckoning with the structures that manufacture vulnerability, inequality, fear, isolation and harm. Because discrimination is not abstract, it is written into statute books, embedded in institutional practice and lived daily, viscerally, by millions of people whose lives bear the cost of laws that were never designed to protect them.
Consider the intersection of structural discrimination and HIV risk. New research published in Social Science & Medicine has put evidence to what advocates have long known: hostile legal and societal environments cascade into lived discrimination and measurable HIV-risk dynamics. The study found that higher levels of structural homophobia were consistently associated with increased HIV-risk sexual behaviour.
Across Africa, 31 of 54 countries still prohibit consensual same-sex acts between adults. In four of them, the penalty can be death. A study of 3,191 men who have sex with men across 44 sub-Saharan countries found that where same-sex relationships are legal, men had twice the odds of ever having tested for HIV. The presence of targeted national HIV policies for sexual and gender diverse people was similarly associated with higher testing rates.
When same-sex relationships are criminalised, when LGBTQI+ people face discrimination at work, within their communities and inside their own families, the consequences do not stay contained. Structural homophobia increases exposure to violence. It fosters secrecy and fear. It drives people away from health services. It shapes the conditions under which risk-taking occurs, not because people are reckless, but because safer options have been systematically stripped away. This is not conjecture.
In the podcast Crossing the Last Mile, LGBTQ+ activist and human rights advocate, Richard Lusimbo, speaks with candour about what it means to navigate life and healthcare under a punitive law, the impossible calculations people are forced to make simply to stay safe. His account gives human texture to what the numbers are trying to tell.
Discriminatory national climates correlate not only with higher rates of verbal and physical abuse, but with a greater likelihood of unprotected sex with casual partners. In countries with weaker civic space and accountability, the relationship is even stronger.
The research estimates that the direct association between structural homophobia and HIV-risk sexual behaviour is twice as large in less democratic contexts as in more democratic ones. Criminalisation and stigma erode trust in institutions. They discourage testing. They disrupt access to treatment and HIV prevention tools like PrEP. When people are forced into the shadows, prevention becomes a ghost: present in policy, absent in people’s lives.
But the damage of stigma extends far beyond HIV. Discrimination becomes embodied harm. A study published in Nature Human Behaviour, drawing on data from 82 324 sexual and gender diverse people across 153 countries, found that both a country’s homophobic climate and family-level homophobia are strongly associated with lower well-being. Critically, economic precarity magnifies that damage. The weight of a homophobic climate on well-being was nearly halved for economically secure participants compared with those who are economically deprived. When people are already struggling financially, discrimination hits harder and cuts deeper. Social safety nets alone cannot be enough if structural stigma remains in place.
Discrimination also does not only operate outside people. It gets inside them. In sub-Saharan Africa, research found that internalised homonegativity among sexual and gender diverse men was strikingly high, with a mean score of 5.3 on a 1 to 7 scale, compared with averages of 2.0 to 2.5 reported in studies elsewhere. This is what structural stigma does: it gets under the skin. It shapes self-worth, generates chronic stress and recalibrates the daily calculus of whether it is safe to seek help.
The pathway from discriminatory law to adverse health outcome is not theoretical. It is documented, quantifiable and avoidable.
For decades, the global HIV response has taught that epidemics do not spread in a vacuum. They travel along fault lines of injustice. They exploit the gaps left by exclusion. Wherever rights are denied, health suffers. When governments adopt inclusive policies, actively combat stigma and defend equal rights, they reduce health risk precisely by advancing social justice. These are not competing goals. They are the same goal.
The ask to policymakers on this Zero Discrimination Day is not complicated: build societies where equality is treated as the infrastructure of health that it truly is. The evidence is clear. The moral case is clear. What remains is the will to act.
If we want zero new infections, we must first commit to zero discrimination.
Erik Lamontagne is a Senior Economist at UNAIDS