Health-related stigma describes a socio-cultural process in which social groups are devalued, rejected and excluded on the basis of a socially discredited health condition [7]. Stigma may be understood in terms of the different ways it manifests at the self, social and structural levels [8–10]. Self-stigma is defined as a subjective process that is ‘characterized by negative feelings (about self), maladaptive behavior, identity transformation or stereotype endorsement resulting from an individual's experiences, perceptions, or anticipation of negative social reactions’ on the basis of a stigmatized social status or health condition [2]. Social stigma describes ‘the phenomenon of large social groups endorsing stereotypes about and acting against a stigmatized group’[8]. Structural stigma refers to the rules, policies and procedures of institutions that restrict the rights and opportunities for members of stigmatized groups [8,11]. Examples of structural stigma are the negative attitudes and behaviors of representatives of public institutions, such as people who work in the health and criminal justice sectors. Disagreement exists in the literature concerning the levels of stigma, including how many exist and how they are defined. For instance,
