Stigma as evidence: A critical discourse analysis of research on MSM HIV PrEP stigma

While stigma is often theorized relationally, in evidence-based paradigms it is treated as a factor. How does this objectification of inequalities function within healthcare discourses and what effects does it have? This article makes the case that stigma when treated as evidence operates as an empty signifier. Beyond strictly indexing inclusion and equity issues facing men who have sex with men (MSM), "stigma as evidence" may play a transformational role in the governance and sexual health politics of the LGBT* community. An analysis of 57 academic articles on PrEP stigma affecting MSM between 2011 and 2022 illustrates how stigma, when treated as a factor, capitalizes on the abstraction and generalization processes common in evidence-based medicine to depersonalize and fragment the values and practices deemed problematic by health researchers. These abstractions are then used to critique those values, and valourizing those that support implementation. The result is an apparent reshaping of the community through this discourse. The article explains why stigma may persist as a valuable term in healthcare, despite its placeholder-like quality with implications for research and policy on stigma in healthcare.