The value of reducing HIV stigma Robert J. Brent Department of Economics, Fordham University, 441 East Fordham Road, Bronx, NY 10458, USA article info Article history: Received 23 March 2015 Received in revised form 6 January 2016 Accepted 9 January 2016 Available online 11 January 2016 Keywords: HIV-stigma Valuing benefits Older people abstract HIV-stigma is a major reason why HIV continues to be a global epidemic. Interventions targeting HIV- stigma are therefore necessary. To find an intervention that is worthwhile, a Cost-Benefit Analysis is needed which compares costs and benefits. There are many documented costs of HIV-stigma. What is missing is a valuation of the benefits of reducing HIV-stigma. The purpose of this paper is to present a general method that can be used to value the benefits of stigma reduction programs. The method in- volves estimating the marginal rate of substitution (MRS) between stigma and income in the utility function of older people with HIV. To illustrate how our framework can be used, we applied it to a sample of just over 900 people coming from the 2005-06 ROAH study (Research on Older Adults with HIV) in New York City. © 2016 Elsevier Ltd. All rights reserved. 1. Introduction By the end of 2010 there were 1.2 million people in the US living with HIV/AIDS. Between 2006 and 2009, the average number of new infections in the US was between 48,600 and 56,000, see UNAIDS (2011). UNAIDS call stigma a “social enabler”. UN Secretary General, Ban Ki-Moon (2008) states that stigma is a chief reason why the AIDS epidemic continues to devastate societies worldwide. He argues that because of stigma people do not get tested and, if tested and found positive, do not seek treatment. Dieffenbach and Fauci (2009) report that treatment is now considered a major way that HIV can be prevented. So by hindering treatment, HIV trans- mission increases greatly because of the existence of stigma. The adverse effect of stigma is clearest in the context of South Africa where stigma leads many in affected areas to fail to accept that HIV is the cause of increased deaths, see Taylor and Kvalsvig (2008). Because HIV infection is an invisible health condition, HIV stigma is directly linked to disclosure. If stigma is internalized, it may make disclosure difficult, or even impossible. Once being HIV positive is disclosed, it exposes the person to the risk of experi- encing various negative stereotypes, prejudices and forms of discrimination. In contrast to various other stigmatized health conditions, HIV infection was believed in the 1990s in the US to be acquired exclusively by stigmatized - and even criminalized - forms of behavior. Historically, these were homosexual relationships of men, the sharing of needles by illegal drug users, and men visiting commercial sex workers. It is only relatively recently, since 2000, that the general public became aware of the possibility of HIV infection also by means of non-stigmatized forms of behavior, such as heterosexual relations or transmission from mother to child. The association of HIV infection with stigmatized forms of behavior, however, still constitutes an integral part of the stigma related to HIV, see Herek et al. (2002). Michael Sidibe, the UNAIDS executive director, argues in his introduction to UNAIDS (2012a) that stigma is undermining the HIV response across the world and that this will continue until we make major investments in programs that reduce such stigma. To judge whether any investment would be worthwhile it is necessary to carry out a Cost-Benefit Analysis (CBA) of stigma interventions. Many effective interventions have been identified and UNAIDS (2012b) has developed a tool for estimating the costs. But, we need also to estimate the benefits to be able to fully evaluate the potential programs. The purpose of this paper is to present a gen- eral method that can be used to value the benefits of stigma reduction programs in order that CBAs can be undertaken in the future (to see how CBA is applied in the health care field refer to Brent, 2015). Although we will be focusing on HIV stigma, it is important to recognize that stigma is a widespread phenomenon that prevents access to services in many branches of the health care field. We give five examples without claiming that we are in any way being exhaustive. (i) Porter et al. (2009) report that stigma presents a barrier to managing chronic illness by preventing people from being tested, especially for TB. (ii) McSween (2002) shows that E-mail address: brent@fordham.edu. Contents lists available at ScienceDirect Social Science & Medicine journal homepage: www.elsevier.com/locate/socscimed http://dx.doi.org/10.1016/j.socscimed.2016.01.014 0277-9536/© 2016 Elsevier Ltd. All rights reserved. Social Science & Medicine 151 (2016) 233e240