Every year on March 1st, the world marks Zero Discrimination Day, a moment to reaffirm the fundamental principle that everyone, regardless of their health status, identity, or circumstance, has the right to live with dignity and without fear of bias, stigma, or exclusion. While this day serves as a rallying call against all forms of discrimination, it holds profound significance in the context of HIV-related stigma and its intersection with broader societal prejudices.  Discrimination does not exist in a vacuum; rather, it is the manifestation of deep-seated stigma, which in turn is reinforced by punitive policies, including the criminalization of people living with HIV (PLHIV) and marginalized populations.

Stigma is the precursor to discrimination. It operates at multiple levels – internalized, social, and structural – creating an environment where individuals affected by HIV face barriers to healthcare, employment, and social participation. Internalized stigma leads PLHIV to experience shame, affecting their mental well-being and willingness to seek care. Social stigma fosters rejection by family, peers, and communities. Structural stigma, perhaps the most insidious, is embedded in laws, policies, and institutional practices that reinforce inequities and limit access to fundamental rights.

This continuum from stigma to discrimination can be seen in healthcare settings where PLHIV may encounter breaches of confidentiality, denial of services, or substandard care due to bias. It manifests in employment, where individuals may be dismissed or denied opportunities based on their HIV status. It plays out in legal systems where punitive laws criminalize HIV exposure, non-disclosure, and transmission – policies that are often scientifically outdated, overly broad, and disproportionately applied against already marginalized communities.

The criminalization of PLHIV remains one of the starkest forms of discrimination, contradicting public health evidence and human rights norms. More than 130 countries have laws that specifically criminalize aspects of HIV transmission, exposure, or non-disclosure, despite compelling evidence that such laws do not reduce HIV transmission but rather drive people away from testing and care. Criminalization disproportionately affects women, LGBTQ+ individuals, sex workers, and migrants, reinforcing existing inequities. In some cases, people have been prosecuted despite having an undetectable viral load, meaning zero risk of sexual transmission. Others have been imprisoned even when no intent to harm was present, reflecting a legal landscape that prioritizes punishment over prevention.

Additionally, broader criminalization of marginalized populations—including laws targeting LGBTQ+ communities, drug users, and sex workers – exacerbates the vulnerability of these groups to HIV. By forcing individuals into the shadows, these laws create an environment of fear and exclusion, pushing people away from essential services and increasing the risk of HIV acquisition. Decriminalization is not only a human rights issue but a public health imperative.

HIV-related discrimination rarely exists in isolation. Instead, it intersects with other forms of marginalization, compounding barriers to equity and justice. Women and girls living with HIV face heightened levels of stigma, violence, and legal oppression, particularly in contexts where reproductive rights are restricted, and access to care is gendered. In many countries, BIPOC communities experience higher rates of HIV yet face systemic barriers to healthcare, discriminatory law enforcement, and medical racism. In more than 60 countries, homosexuality remains criminalized, making it nearly impossible for LGBTQ+ individuals to access HIV prevention and treatment services safely. And poverty and economic instability exacerbate disparities in access to HIV services, with the criminalization of homelessness, drug use, and sex work further entrenching inequality.

Ending HIV-related discrimination requires a multi-sectoral approach that tackles stigma at all levels while dismantling punitive legal frameworks that marginalize PLHIV and affected communities. Governments must repeal laws criminalizing HIV exposure, non-disclosure, and transmission, as well as laws targeting LGBTQ+ individuals, sex workers, and people who use drugs. Public campaigns must shift narratives from fear to empowerment, emphasizing that PLHIV on HIV treatment with an undetectable viral load cannot pass on HIV sexually (Undetectable = Untransmittable, U=U).

Additionally, we must push for legal protections against discrimination in employment, healthcare, and housing while ensuring accountability for human rights violations. The leadership of PLHIV and key populations must be central to HIV responses, shaping policies and services that reflect lived realities. Investment in education, economic empowerment, and social protection programs can reduce vulnerabilities that fuel both HIV risk and discrimination.

On Zero Discrimination Day 2025, and given the hostile and politically charged environment we are confronting in the United States, we must move beyond symbolic gestures to bold action. Ending discrimination against PLHIV and marginalized communities is not only a human rights obligation but a necessity for ending the HIV epidemic. On this day – and every day – let’s reaffirm that health, freedom, and human rights belong to all, not just to some.

This Zero HIV Stigma blog was written by Dr. José M. Zuniga, who is President/CEO of the International Association of Providers of AIDS Care (@IAPAC) and the Fast-Track Cities Institute (@FTC2030).