Malaria elimination without stigmatization: a note of caution about the use of terminology in elimination settings

This commentary offers a note of caution about the negative social impact that may be inadvertently generated through malaria elimination activities. In particular, the commentary is concerned with the practice of describing people who remain at risk of malaria in low transmission settings as 'hotpops' or 'reservoirs of infection'. The authors argue that since those at risk of malaria in elimination settings are often already socially marginalized - such as migrants, indigenous groups, ethnic minorities and poor rural communities - that care should be taken to avoid implementing programmes in ways that may inadvertently add to the social stigmatization of those most at risk of malaria in a low transmission setting. Programmes should avoid using language that identifies particular groups as a source of infection, and instead begin a broader shift in orientation toward engaging constructively with communities within elimination strategies. Programmes should promote monitoring and evaluation to ensure that unintended negative consequences such as stigma do not occur; advocate for appropriate resourcing (human, financial, other) to minimize the risk of short cuts being used to achieve an end game that may discriminate against specific groups; and strengthen community engagement activities in elimination setting to avoid targeting stigmatized groups and to empower communities to prevent outbreaks and re-introduction of malaria. In this way malaria elimination can be achieved without stigmatization.