The Lancet
Mar 12, 2016 Volume 387 Number 10023 p1027-1132
http://www.thelancet.com/journals/lancet/issue/current
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Editorial
The health crisis of mental health stigma
The Lancet
DOI: http://dx.doi.org/10.1016/S0140-6736(16)00687-5
Many people with mental illness experience shame, ostracism, and marginalisation due to their diagnosis, and often describe the consequences of mental health stigma as worse than those of the condition itself. Interventions to address stigma educate about mental illness and overcome the stereotypes that underlie prejudicial reactions. Along with pharmacological and psychological therapies, stigma interventions have emerged as potentially valuable and complementary tools.
In today’s Lancet, Graham Thornicroft and colleagues review the evidence for effectiveness of interventions to reduce mental health stigma and discrimination, and conclude that they can work at an individual and population level. The evidence of benefit was strongest for interventions involving an individual with lived experience of mental illness, with sustained commitment to delivery over a long period…

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Review
Evidence for effective interventions to reduce mental-health-related stigma and discrimination
Graham Thornicroft, Nisha Mehta, Sarah Clement, Sara Evans-Lacko, Mary Doherty, Diana Rose, Mirja Koschorke, Rahul Shidhaye, Claire O’Reilly, Claire Henderson
DOI: http://dx.doi.org/10.1016/S0140-6736(15)00298-6
Summary
Stigma and discrimination in relation to mental illnesses have been described as having worse consequences than the conditions themselves. Most medical literature in this area of research has been descriptive and has focused on attitudes towards people with mental illness rather than on interventions to reduce stigma. In this narrative Review, we summarise what is known globally from published systematic reviews and primary data on effective interventions intended to reduce mental-illness-related stigma or discrimination. The main findings emerging from this narrative overview are that: (1) at the population level there is a fairly consistent pattern of short-term benefits for positive attitude change, and some lesser evidence for knowledge improvement; (2) for people with mental illness, some group-level anti-stigma inventions show promise and merit further assessment; (3) for specific target groups, such as students, social-contact-based interventions usually achieve short-term (but less clearly long-term) attitudinal improvements, and less often produce knowledge gains; (4) this is a heterogeneous field of study with few strong study designs with large sample sizes; (5) research from low-income and middle-income countries is conspicuous by its relative absence; (6) caution needs to be exercised in not overgeneralising lessons from one target group to another; (7) there is a clear need for studies with longer-term follow-up to assess whether initial gains are sustained or attenuated, and whether booster doses of the intervention are needed to maintain progress; (8) few studies in any part of the world have focused on either the service user’s perspective of stigma and discrimination or on the behaviour domain of behavioural change, either by people with or without mental illness in the complex processes of stigmatisation. We found that social contact is the most effective type of intervention to improve stigma-related knowledge and attitudes in the short term. However, the evidence for longer-term benefit of such social contact to reduce stigma is weak. In view of the magnitude of challenges that result from mental health stigma and discrimination, a concerted effort is needed to fund methodologically strong research that will provide robust evidence to support decisions on investment in interventions to reduce stigma.

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Comment
NextGen HIV prevention: new possibilities and questions
Kenneth H Mayer
Published Online: 04 March 2016
Summary
In less than a decade, HIV prevention has evolved from a reliance on education, behavioural interventions, and use of condoms to focusing on the optimum use of antiretrovirals to suppress infectiousness and for primary prophylaxis. Landmark studies have shown the efficacy of the early initiation of treatment for people infected with HIV,1 and the use of oral pre-exposure prophylaxis (PrEP) for those at highest risk to decrease HIV transmission.2 Despite PrEP being shown to be efficacious in most trials in which it was assessed, the paramount importance of consistent use of preventive medication was shown when oral and topical tenofovir-based regimens did not show efficacy in three studies involving young African women, primarily because of suboptimum adherence.