Stories

Stigma Is Invisibility:

27/05/2026

Stigma Is Invisibility: HIV, Fear, Anger, Addiction, and the Silence We Must Break

By Babi Rani Paudel

Stigma is invisibility.

It is fear.
It is anger.
It is silence.
It is shame.
It is the way society makes a person disappear while they are still alive.

For many people today, HIV is no longer the same medical story it was in the 1980s and 1990s. Treatment has changed. Science has changed. A person living with HIV who is diagnosed, supported, and taking effective treatment can live a long and healthy life. When HIV is undetectable through treatment, it cannot be sexually transmitted. This is known as U=U — Undetectable equals Untransmittable — and the World Health Organization recognises that viral suppression protects health and prevents onward sexual transmission.

But society has not changed as fast as medicine.

The virus is now manageable.
The stigma is still dangerous.

Stigma is not only someone shouting insults. Stigma is also the quiet distance after disclosure. It is the friend who stops calling. It is the family member who looks at you differently. It is the gossip that travels faster than truth. It is the nurse, doctor, student, receptionist, neighbour, husband, wife, lover, or community member who forgets that a person living with HIV is still a full human being.

Stigma makes people hide medication.
Stigma makes people avoid testing.
Stigma makes people afraid to walk into a clinic.
Stigma makes people feel dirty when they are not dirty.
Stigma turns fear into anger, anger into silence, and silence into loneliness.

This is why HIV must not be spoken about only as my story. It is bigger than one person. It is bigger than one body. It is bigger than one community. HIV touches gay men, bisexual men, married men who have sex with men, heterosexual men and women, transgender people, sex workers, migrants, refugees, international students, wives, girlfriends, young students, older people, and people who never imagined HIV could become part of their lives.

HIV is a virus.
It is not a moral failure.
It is not a punishment.
It is not proof that someone is bad, sinful, irresponsible, or dangerous.

Yet for many years, people living with HIV have carried two burdens: the medical condition of HIV and the social wound of stigma. Sometimes the stigma becomes heavier than the virus itself.

In Australia, there has been real progress. The Kirby Institute reported 757 first-ever HIV diagnoses in Australia in 2024, a 27% decline since 2015. But the same report showed that 38.4% of HIV notifications in 2024 were late diagnoses, meaning many people had probably lived with HIV for years before diagnosis. Late diagnosis was especially high among people born in Southeast Asia, Oceania outside Australia, and Sub-Saharan Africa.

These facts show us that medicine alone is not enough. People also need trust, language support, privacy, cultural safety, peer support, and freedom from shame.

For migrant communities, HIV can become deeply hidden. Some people fear family rejection. Some fear religious judgment. Some fear gossip in their cultural community. Some fear visa problems. Some do not understand how to access healthcare in Australia. Some come from countries where HIV is still treated like disgrace, punishment, or social death.

For them, walking into a clinic is not always a simple medical action. It can feel like walking into exposure.

A married man may be living in fear because he has sex with men but cannot speak about it. A bisexual man may be invisible because society forces him to choose one label. A wife may be at risk but invisible because people assume marriage is always safe. A transgender woman may be judged before she is cared for. A young international student may be alone, scared, and unsure where to go. A migrant worker may be silent because of language, culture, and shame.

When HIV education speaks only to one identity, it misses many lives.

This is not about blaming gay men. This is not about blaming bisexual men. This is not about blaming married men, transgender people, migrants, women, or anyone else. Blame does not prevent HIV. Shame does not prevent HIV. Fear does not prevent HIV.

Testing prevents late diagnosis.
Treatment prevents transmission.
Education prevents misinformation.
Compassion brings people into care.

We must also speak honestly about another painful truth: stigma can lead people into addiction.

When people are invisible, they look for ways to survive. Some people use alcohol to sleep, to forget, to numb the fear, or to quiet the shame. Some use narcotic drugs or other substances because the pain inside feels too loud. Some are not trying to destroy themselves; they are trying to manage trauma without proper support.

This is coping management, but it can become dangerous.

A bottle can become a listener.
A drug can become temporary silence.
A substance can become the only place where pain feels quiet.

But alcohol and drugs do not remove stigma. They often create another layer of stigma. Then the person is judged twice: first for HIV, then for addiction. They become even more invisible.

Research has linked HIV-related stigma with poorer mental health, including depression, anxiety, suicidal thoughts, reduced social support, and alcohol-use disorders. Health Equity Matters also describes stigma as a major barrier for people who inject drugs when accessing HIV testing and treatment, and highlights the need for peer support, harm reduction, and stigma-free healthcare.

This is why addiction must not be treated as moral weakness. Addiction can be connected to trauma, rejection, fear, poverty, loneliness, migration stress, sexuality shame, gender discrimination, family pressure, and untreated mental health pain.

A person living with HIV who also struggles with alcohol or drugs does not need more judgment. They need integrated care. They need HIV treatment, mental health support, addiction support, harm reduction, counselling, peer workers, and safe healthcare workers who do not shame them.

Stigma creates hiding.
Hiding creates pain.
Pain can create addiction.
Addiction can create more stigma.

This cycle must be broken with care, not cruelty.

I also want to correct something important: this is not only about Geoffrey.

Geoffrey has lived with HIV since 1988. People like Geoffrey are living history. They survived a time when HIV was surrounded by death, fear, rejection, and public misunderstanding. They remember when treatment was limited. They remember when friends died. They remember when newspapers, families, politicians, and even some healthcare workers treated HIV as shame instead of illness.

But Geoffrey is not alone.

There are many legends. Many elders. Many survivors. Many activists. Many peer workers. Many nurses, doctors, counsellors, community workers, and people living with HIV who fought so that today we have better healthcare, better medication, better public education, peer support, legal reform, and more dignity.

The healthcare set-up we have today did not appear by luck. It was built through pain, courage, protest, funerals, love, community organising, medical research, and the voices of people who refused to disappear.

These legends taught the world that people living with HIV are not dangerous. They are human. They are leaders. They are teachers. They are the reason younger generations can now say U=U, access treatment, speak to peer workers, and live longer lives.

We must honour them while also protecting the people who are still hidden today.

The law also has a history in this story. Victoria once had an HIV-specific criminal law, Section 19A, which criminalised intentional HIV transmission and was criticised for unfairly targeting and stigmatising people with HIV. The law was repealed in 2015, and community advocates argued that HIV should be treated as a public health issue, not mainly as a criminal justice issue.

This matters because fear of punishment can make people hide. When people hide, they may not test. When they do not test, they may not receive treatment. When they do not receive treatment, both individual health and public health suffer.

Responsibility matters. Honesty matters. Consent matters. Treatment matters. But revenge, gossip, panic, and moral judgment do not protect communities. Public health must be based on testing, treatment, counselling, partner support, education, and compassion.

Healthcare services must also look honestly at their own role. Many healthcare workers are kind and professional, but stigma can still appear in healthcare settings through tone, language, assumptions, lack of privacy, rushed appointments, or poor understanding of HIV, sexuality, gender diversity, addiction, migration, and culture. The World Health Organization has said HIV-related stigma and discrimination remain significant barriers to HIV care, and that health workers need skills to deliver stigma-free services.

This is especially important for young nursing students, medical students, triage nurses, reception staff, interpreters, and community health workers.

HIV education must not only teach blood tests, viral loads, and medication. It must teach humanity. It must teach U=U. It must teach confidentiality. It must teach that people living with HIV are not dangerous. It must teach that a person who uses alcohol or drugs still deserves care. It must teach that a transgender woman is not a problem. A migrant is not a problem. A bisexual man is not a problem. A married man afraid to speak is not a monster. A wife living with HIV is not shameful.

A healthcare worker’s tone can either open the door to care or close it.

Access is also part of stigma. Melbourne Sexual Health Centre now states that from December 2 it no longer has a walk-in service and asks people to call first to speak with a nurse through tele-triage before coming to the clinic. The nurse may book an appointment or help the person find another suitable service. MSHC also states that it is a government-funded specialist service for specific populations and cannot test or treat everyone who calls or attends.

There may be practical reasons for tele-triage, including high demand and the need to prioritise urgent cases. But we must ask who may be left behind.

What happens to the migrant who cannot explain sexual symptoms confidently in English?
What happens to the person living in a crowded house with no private place to call?
What happens to the married man who is terrified to speak honestly on the phone?
What happens to the transgender woman who has already been humiliated in healthcare?
What happens to the person using alcohol or drugs who fears being judged?
What happens to the international student who does not know their rights?
What happens to the hidden person living with HIV who needs human contact, not another barrier?

For some people, phone triage may help. For others, it may become another wall.

Public health needs many doors: phone triage, walk-in options, peer workers, interpreters, community testing, self-testing, harm reduction services, migrant outreach, addiction support, and culturally safe care.

Australia has made important progress in treatment access. NAPWHA states that HIV testing and treatment is now free for everyone in Australia, even without a Medicare card, although some states and territories may charge a co-payment. This includes people on student, travel, and temporary work visas.

But information does not reach everyone equally. A service can exist, and people may still be too afraid to use it. Treatment can be available, and people may still hide because of shame. A clinic can be welcoming, and people may still fear being recognised at the door.

This is why HIV education must move beyond hospitals. It must reach schools, universities, migrant communities, religious spaces, workplaces, media, families, and social services. Young students must learn that HIV is not a joke, not gossip, not a punishment, and not a reason to reject someone. Healthcare students must learn that stigma can damage health as seriously as poor treatment. Families must learn that rejection can harm more than the diagnosis itself.

My message is not only about me.
It is not only about Geoffrey.
It is about everyone made invisible by HIV stigma.

It is about the person afraid to test.
It is about the wife who does not know how to ask questions.
It is about the married man trapped between sexuality, culture, fear, and shame.
It is about the young student who thinks HIV means life is finished.
It is about the migrant who does not know services exist.
It is about the transgender person who fears judgment before care.
It is about the person using alcohol or narcotic drugs to cope with loneliness.
It is about the legends who survived the hardest years and helped build today’s healthcare system.

HIV is not the end of humanity.
Stigma is the thing that tries to erase humanity.

We cannot fight HIV with silence.
We cannot fight stigma with anger.
We cannot protect families through shame.
We cannot protect communities by making people invisible.
We cannot help people with addiction by judging them.

We need truth.
We need care.
We need harm reduction.
We need mental health support.
We need peer workers.
We need culturally safe healthcare.
We need nurses and doctors who understand both HIV and stigma.
We need communities brave enough to speak.

The truth is simple:

HIV is a virus.
Addiction is not a moral failure.
Stigma is invisibility.
Fear and anger are part of stigma.
Silence is part of stigma.
Shame is part of stigma.

Every person living with HIV deserves to be seen, heard, treated, supported, respected, and loved.

Also read Babi’s moving story ‘My Journey Through Stigma and Discrimination‘ published by Poslink – Living Positive Victoria

                                 Babi Rani Paudel