'The power of universality is that everybody is treated the same': Exploring the possibilities and limitations of a universal approach to stigma reduction among BBV/STI sector stakeholders in Australia.

backgroundThere are increasing calls for cross-cutting approaches to reducing stigma in health systems that do not silo specific identities, conditions, or practices. In our previous work, we proposed a 'universal precautions' approach to addressing stigma and its negative effects (Treloar et al. in Harm Reduct J 19(1):74, 2022), whereby health systems assume that all people who enter a health service might be concerned about being treated negatively or excluded in some way. This paper explores the possibilities and limitations of such an approach to stigma reduction by canvassing key stakeholder perspectives.

methodsQualitative interviews were conducted with 20 key stakeholders with extensive experience working within the alcohol and other drugs, blood-borne viruses, and sexually transmissible infections sectors. Participants were asked to reflect on the concept of a universal precautions approach to stigma reduction, including its acceptability, feasibility, utility in practice, and key challenges.

resultsAlthough interview participants strongly advocated for a need to address all stigma within health care, there were mixed attitudes towards the use of the term, 'universal precautions'. Some participants believed it would be useful to draw on a lexicon more familiar to health workers, while others expressed ambivalence and confusion about the term. Participants reflected on the possibilities of universality, in treating everyone with respect and providing non-judgemental care, while also emphasising that different client populations have specific needs that must be addressed. Many participants emphasised strongly that such an approach would need to be embedded at a systemic level, including having support from executive leadership, to address the structural forces that (re)produce stigma. Participants emphasised that centring the voices and perspectives of people with lived experience of stigma is integral to any approach to reducing stigma in health systems.

conclusionsFindings highlight the various possibilities of adopting a universal approach that recognises the diversity and intersections in experiences of stigma. This research informs the development and implementation of novel stigma reduction initiatives in health care settings.