The risk-stigma paradox: How risk-focused HIV prevention produces and distorts vulnerability

We currently have a diverse toolbox of HIV prevention modalities that can be leveraged to reduce new HIV infections. Unfortunately, a focus on changing risk perceptions in HIV prevention persist despite limited evidence. In this viewpoint, I describe how an individual-level focus on risk perception fuels stigma while stigma obscures risk perception. I argue that efforts to bolster HIV prevention should focus first and foremost on ascertaining the various determinants of uptake for the various prevention modalities available, and acknowledge that people’s preferences for prevention strategies are neither universal nor static. We should therefore engage in ongoing monitoring of the many sociocognitive and structural determinants of the different prevention modalities over time, and make our sexual health services free from stigma, judgment, and risk eligibility criteria.