A new project launched this month will tackle how the issue of shame is preventing the effective treatment of HIV.
Dr Phil Hutchinson, Senior Lecturer in Philosophy at Manchester Metropolitan University and author of the book "Shame and Philosophy" has received funding from the British HIV Association to look at how to help clinicians deal with shame in clinical settings.
He will be working with Prof Jane Anderson to produce guidelines and design deliberative fora for HIV clinicians. Prof Anderson is Director of the Centre for the Study of Sexual Health and HIV at Homerton University Hospital, London and HIV Lead at Public Health England.
Dr Hutchinson said: "When visiting a sexual health clinic and giving a stranger details of your past behaviour, shame can be a significant contributing factor in people being less than honest. We are looking for ways clinicians can mitigate shame in such contexts."
Public Health England estimates that 30% of people living with HIV don't know they have the virus, and of those who receive a diagnosis, 40-50% are 'late diagnoses', which means they could have been living with the virus for a couple of years.
Dr Hutchinson said that the bio-chemical advances in HIV treatment since the mid-1990s have made a huge difference to HIV mortality rates, made a huge difference to the quality of life of those living with the virus, and rendered the virus non-transmissible and fully supressed for many of those on treatment. In contrast, the extra-bio-chemical or psycho-social, political and cultural aspects of HIV treatment and prevention have progressed little in the same time.
Stigma and shame are still major factors in nearly all aspects HIV treatment and prevention and they severely hamper the practical efficacy of the bio-chemical interventions which have progressed so much in the past twenty years.
He said: "It's a huge problem in HIV - it's a virus like any other and current antiretrovirals are very effective. Many people still have this 1980s idea of an HIV diagnosis meaning dying of AIDS, but aside from taking three pills a day you can, if you have access to the drugs and are not unfortunate enough to suffer drug toxicity issues, live a full, healthy life - but there's still a lot of stigma about it.
"HIV serves as a vector for society's existing prejudices towards sexuality, sexual behaviour, immigration, ethnicity and so on. The argument is that you can't think of HIV purely on the biomedical model because it's not just about the virus and about the drugs."
Dr Hutchinson has also received funding from the Sexually Transmitted Infection Research Foundation (STIRF) to look into how shame is a barrier to people going for routine sexual health tests.