HIV activism offers a roadmap for tackling weight stigma
10 November 2026 - Wits University
Although HIV and obesity are not mirror images, lessons from the HIV response could accelerate fairer and more effective care for people living with obesity.
These were the findings in the paper titled Weight gain in people living with HIV published as part of The Lancet HIV Series on 8 November.
This Series highlights how HIV and weight stigma can intersect, and how community-led, integrated services can help address both.
By adapting HIV’s activist-built tools, i.e., community leadership, stigma measurement, legal protection and integrated treatment access, weight-stigma reduction can move beyond blame and toward care that treats obesity as a health issue, not a moral failing.
“Obesity and HIV are shaped by stigma that extends beyond public prejudice. In HIV, moral judgements about sex, loss of autonomy, and enduring associations with death based on widespread images of HIV as a wasting disease, have delayed care-seeking and sustained discrimination,” says Dr Simiso Sokhela of Ezintsha at Wits University, South Africa, and a Series author. “Effective treatment has reduced some enacted stigma, but anticipated and internalised stigma often persist, even among people with an undetectable viral load.”
Weight stigma shares important features with HIV stigma: Body size is immediately visible, allowing judgement before any clinical or workplace interaction. It is also commonly framed as a failure of personal willpower, despite the roles of genetics, metabolic differences, medications, food environments, and structural poverty.
These attitudes have consequences. Evidence shows that weight stigma is associated with poorer mental health, avoidance or delay of care, and discrimination. Whether weight stigma affects adherence to antiretroviral therapy remains poorly understood and requires research.
A collision of epidemics
There is an increasingly complex overlap between HIV and obesity. HIV was associated with wasting and visible thinness, embedding weight loss itself in stigma. In some settings, cultural ideals that valued larger bodies as signs of health, prosperity, or beauty were reinforced when a larger body appeared to signal presumed HIV-negative status.
Modern antiretroviral regimens have changed this landscape. Newer integrase inhibitor-based therapies, particularly when combined with tenofovir alafenamide, are consistently associated with greater weight gain than older regimens.
The largest increases have been observed among black people, especially women, likely reflecting a combination of biological factors and possible unmeasured socioeconomic or structural confounders, rather than race itself. This weight gain is associated with rising burdens of hypertension, diabetes, and other cardiometabolic conditions.
“For people living with HIV who also carry higher body weight, these are not two stigmas experienced side by side. They are a single, intersecting experience, shaped by HIV-related prejudice, weight bias, and wider inequities,” says Professor Francois Venter, Wits Ezintsha Executive Director and lead author of the Series. “Research on women living with HIV similarly finds that stigma related to body size intersects with HIV status, gender, race, age, and other forms of discrimination.”
Castilho, whose research focuses on long-term outcomes and aging with HIV, had long hoped to bring a geriatrician into the clinic. Bryant reached out during her geriatrics fellowship at VUMC.
“This was the partner I was waiting for,” Castilho said.
The service partners with Nashville Cares, whose Healthy University program offers peer support and exercise programs. With help from Vanderbilt Health implementation science experts, the team is tracking referrals and gathering patient and provider feedback. Long-term plans under consideration include accepting consultation referrals from other HIV clinics in the region, such as those at Meharry Medical College and Nashville Cares, and exploring telehealth for rural patients.
Contact:
Deborah Minors
Senior Communications Officer | Wits Communications
E: Deborah.Minors@wits.ac.za
T: +27 11 717 1024
M: +27 72 240 4990
W: http://www.wits.ac.za/
Source: Wits University
https://www.wits.ac.za/news/latest-news/research-news/2026/2026-11/hiv-activism-offers-a-roadmap-for-tackling-weight-stigma.html
“Reproduced with permission - University of the Witwatersrand (Wits University), Johannesburg ”
University of the Witwatersrand (Wits University), Johannesburg
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