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This paper presents key findings of a situational analysis of institutional and structural levels of HIV/AIDS-related discrimination in Beijing, China, with a focus on the area of health care. Initially slow to respond to the presence of HIV, China has altered its approach and enacted strict legislative protection for people living with HIV/AIDS (PLWHA). In order to determine whether this has altered discrimination against PLWHA, this study examined existing legislation and policy, and interviewed key informants working in health care and PLWHA. The overall findings revealed that discrimination in its many forms continued to occur in practice despite China's generally strong legislative protection, and it is the actual practice that is hindering PLWHAs' access to health services. A number of legislative and policy gaps that allow discrimination to occur in practice were also identified and discussed. The paper concludes with a call to rectify specific gaps between legislation, policy and practice. An understanding of the underlying factors that drive discrimination will also be necessary for effective strategic interventions to be developed and implemented.

There is scant research into HIV discrimination, particularly structural and institutional forms of it. This appears, in part, to arise from a prevailing view that the solutions to HIV discrimination are known a priori and in the absence of additional data. The six country studies into HIV discrimination presented in this AIDS Care supplement suggest that this is not the case. There needs to be an acceptance that if the issue of HIV discrimination is to be tackled successfully and based on evidence, then incremental and effortful steps need to be taken to develop that evidence base. This is discussed.

The findings of the six independent studies on institutional forms of HIV discrimination in the Asia Pacific presented in this Special Issue of AIDS Care are integrated. At first glance, the general pattern of the results across the study sites suggests that discrimination is most pertinent in the domain of 'practice' rather than in the domains of law or institutional policy. On closer analysis, however, utilising the qualitative data, this conclusion does not take sufficient account of the cultural context within which the interpersonal interaction (practice) between the health carers and people living with HIV/AIDS occurs. Limitations on the use of anti-discrimination legislations and protective written policies for reducing discrimination in these contexts are discussed. The need for alternative approaches to thinking about discrimination intervention is raised and this is done through a consideration of the strategy of universal precautions.

This paper outlines a six-country study of institutionalised forms of HIV/AIDS-related discrimination in the Asia-Pacific region. Although recognised as a barrier to disease prevention and treatment, very limited data are available on the effects of institutionalised HIV-related stigma and discrimination. Understanding the forms of discrimination within the institutions where they occur is the first step to identifying effective ways of promoting compassionate, non-discriminatory treatment of PLWHA. Thus, the goal of this research project was to document institutional discrimination against PLWHA, as guided by the UNAIDS Protocol for the Identification of Discrimination Against People Living with HIV (2000), in six Asian countries: India, Thailand, Philippines, China, Vietnam and Indonesia. As a precursor to the six individual studies, this paper provides a brief overview of the literature on HIV discrimination, and then describes the UNAIDS Protocol and the shared methodological considerations relevant to all of the study sites. Commonalities in sampling, procedures and analysis are also discussed.

The systematic measurement of HIV/AIDS-related discrimination is imperative within the current rhetoric that holds discrimination as one of the two 'biggest' barriers to HIV/AIDS pandemic intervention. This paper provides a methodological critique of the UNAIDS (2000b) Protocol for the Identification of Discrimination against People Living with HIV (the Protocol). Specifically, the paper focuses on the Protocol's capacity to accurately identify and measure institutional levels of HIV-related discrimination that allows data that are reliable and comparable across time and contexts. Conceptual issues including the Protocol's objective as an indicator versus a direct measure of discrimination and the role of the Protocol as a tool of research versus a tool of advocacy are explored. Design issues such as the operationalization of discrimination, appropriateness of indicator content, sampling and data collection strategies and issues of scoring are also evaluated. It is hoped that the matters outlined will provide readers with ways of critically reflecting and evaluating the findings of the research papers presented in this Special Issue, as well as pointing to ways of improving research design.

HIV-related stigma is regarded as one of the major barriers in the development of effective prevention and care programs; but the stigma associated with HIV stigma is not a singular entity. The stigma of the infection is layered with other stigmas, such as those associated with the routes of transmission (e.g., sex work and injecting drug use) and personal characteristics (e.g., race, religion, ethnicity and gender). In developing programs and policies to overcome HIV-related stigma, cognisance needs to be taken of all the sources of stigma, and how they may interact. A novel method is described for examining the layers of HIV/AIDS-related stigma, and secondary data are adapted to illustrate this. The importance of understanding the layering of stigma for the development of effective interventions is also discussed.