HIV and AIDS:
Stigma and Discrimination

Even the healthcare system is engaged in HIV-related stigma and discrimination

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"Though we do not have a policy so far, I can say that if at the time of recruitment there is a person with HIV, I will not take him. I'll certainly not buy a problem for the company. I see recruitment as a buying-selling relationship. If I don't find the product attractive, I'll not buy it."
- A Head of Human Resource Development, India

Health Care

Many reports reveal the extent to which people are stigmatized and discriminated against by health care systems. Many studies reveal the reality of withheld treatment, non-attendance of hospital staff to patients, HIV testing without consent, lack of confidentiality and denial of hospital facilities and medicines. Also fueling such responses are ignorance and lack of knowledge about HIV transmission.

"There is an almost hysterical kind of fear…at all levels, starting from the humblest, the sweeper or the ward boy, up to the heads of departments, which makes them pathologically scared of having to deal with an HIV-positive patient. Wherever they have an HIV patient, the responses are shameful."
- A retired senior doctor from a public hospital

A survey conducted in 2002 among some 1,000 physicians, nurses and midwives in four Nigerian states, returned disturbing findings. One in 10 doctors and nurses admitted having refused to care for an HIV/AIDS patient or had denied HIV/AIDS patients admission to a hospital. Almost 40% thought a person's appearance betrayed his or her HIV-positive status, and 20% felt that people living with HIV/AIDS had behaved immorally and deserved their fate. One factor fueling stigma among doctors and nurses is the fear of exposure to HIV as a result of lack of protective equipment. Also at play, it appears was the frustration at not having medicines for treating HIV/AIDS patients, who therefore were seen as 'doomed' to die.

Lack of confidentiality has been repeatedly mentioned as a particular problem in healthcare settings. Many people living with HIV/AIDS do not get to choose how, when and to whom to disclose their HIV status. When surveyed recently, 29% of persons living with HIV/AIDS in India, 38% in Indonesia, and over 40% in Thailand said their HIV-positive status had been revealed to someone else without their consent. Huge differences in practice exist between countries and between health care facilities within countries. In some hospitals, signs have been placed near people living with HIV/AIDS with words such as 'HIV-positive' and 'AIDS' written on them.

The way forward

HIV-related stigma and discrimination remains an enormous barrier to effectively fighting the HIV and AIDS epidemic. Fear of discrimination often prevents people from seeking treatment for AIDS or from admitting their HIV status publicly. People with or suspected of having HIV may be turned away from healthcare services, employment, refused entry to a foreign country. In some cases, they may be evicted from home by their families and rejected by their friends and colleagues. The stigma attached to HIV/AIDS can extend into the next generation, placing an emotional burden on those left behind.

Denial goes hand-in-hand with discrimination, with many people continuing to deny that HIV exists in their communities. Today, HIV/AIDS threatens the welfare and well-being of people throughout the world. At the end of the year 2004, 39.4 million people were living with HIV or AIDS and during the year 3.1 million died from AIDS-related illness. Combating the stigma and discrimination against people who are affected by HIV/AIDS is as important as developing the medical cures in the process of preventing and controlling the global epidemic.

So how can progress be made in overcoming this stigma and discrimination? How can we change people attitudes to AIDS? A certain amount can be achieved through the legal process. In some countries people who are living with HIV or AIDS lack knowledge of their rights in society. They need to be educated, so they are able to challenge the discrimination, stigma and denial that they meet in society. Institutional and other monitoring mechanisms can enforce the rights of people living with HIV or AIDS and provide powerful means of mitigating the worst effects of discrimination and stigma.

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However, no policy or law can alone combat HIV/AIDS related discrimination. The fear and prejudice that lies at the core of the HIV/AIDS discrimination needs to be tackled at the community and national levels. A more enabling environment needs to be created to increase the visibility of people with HIV/AIDS as a 'normal' part of any society. In the future, the task is to confront the fear based messages and biased social attitudes, in order to reduce the discrimination and stigma of people who are living with HIV or AIDS.

Sources:

• UNAIDS, AIDS epidemic update, December 2004
• UNAIDS, AIDS epidemic update, December 2003
• UNAIDS, HIV and AIDS - related stigmatization, discrimination and denial: forms, contexts and determinants, June 2000
• UNAIDS, India : HIV and AIDS - related stigmatization, discrimination and denial, August 2001

Next: An epidemic of stigma and discrimination

Last reviewed: 10/05

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