STIGMA AND DISCRIMINATION IS A HEAVY BURDEN IN COMBATING HIV/AIDS

The social, ethical, and economic effects of the AIDS epidemic are still being played out, and no one is entirely certain what the consequences will be. Despite the many grim facts of the AIDS epidemic, however, humanity is armed with proven, effective weapons against the disease like knowledge, education, prevention, and the ever-growing store of information about the virus's actions. To be effective in combating stigma and discrimination HIV/AIDS campaign programmes need to make the challenges towards successful elimination of the virus visible and the factors leading to its spread, discussible. Furthermore, campaign programmes against the pandemic need to make people aware of the existence of HIV and how it is spread, without stigmatizing the behaviours that lead to its transmission. They also need to facilitate discussion about an individual or community's own vulnerability, and how to reduce it. This involves dissipating fear and prejudice against people who are already living with HIV or AIDS.

Successful programmes impart knowledge, counter stigma and discrimination, create social consensus on safer behaviour, and boost AIDS prevention and care skills.

These can be accomplished cost-effectively through mass media campaigns, and through peer/outreach education and life-skills programmes in schools and workplaces.

There have been successful HIV campaign programmes that have demonstrated the enormously positive impact of openness and honesty in facing HIV. Ensuring that counselling and voluntary HIV testing are available, so that an individual can find out her or his HIV status is a further critical ingredient in counteracting denial.

In 2003, when launching a major campaign to scale-up treatment in the developing world the World Health Organization (WHO) claimed that, 'As HIV/AIDS becomes a disease that can be both prevented and treated, attitudes will change, and denial, stigma and discrimination will rapidly be reduced.' However, it is difficult to assess the accuracy of this statement as levels of stigma are hard to measure and a number of small-scale studies have shown that the relationship between increased access to HIV treatment and a reduction in stigma is not always clear. A study of 1,268 adults in Botswana found that stigmatising attitudes had lessened three years after the national programme providing universal access to treatment was introduced. However, the study concluded that although improving access to antiretroviral treatment may be a factor in reducing stigma, it does not eliminate stigma altogether and does not lessen the fear of stigma amongst HIV positive people.

Moreover, as there are many types of stigma it is possible that the availability of treatment may reduce some types of stigma and not others. For example, a study in Tanzania found that, on the one hand, stigma caused by the perception of people living with HIV as weak and therefore a 'burden' on the community had decreased with the uptake of treatment. The tendency of people living with HIV to 'self stigmatise' had also decreased, as contact with not only health professionals but also with other people living with HIV helped them see that they were not alone. On the other hand, 'fear based stigma' was found to have increased. Those studied were concerned that because it was now difficult to differentiate between people infected with HIV, and those who are not, HIV transmission would increase as they would no longer know to "avoid those who 'look ill'".

Community-level stigma and discrimination can manifest as ostracism, rejection and verbal and physical abuse. It has even extended to murder. AIDS related murders have been reported in countries as diverse as Brazil, Colombia, Ethiopia, India, South Africa and Thailand. In December 1998, Gugu Dhlamini was stoned and beaten to death by neighbours in her township near Durban, South Africa, after speaking openly on World AIDS Day about her HIV status. It is therefore not surprising that 79 percent of people living with HIV who participated in a global study, feared social discrimination following their status disclosure.

Community level stigma and discrimination towards people living with HIV is found all over the world. A community's reaction to somebody living with HIV can have a huge effect on that person's life. If the reaction is hostile a person may be discriminated against and may be forced to leave their home, or change their daily activities such as shopping, socializing or schooling. The fact that stigma remains in developed countries such as America, where treatment has been widely available for over a decade, also indicates that the relationship between HIV treatment and stigma is not straightforward. Some studies have estimated an increased percentage of HIV infected individuals been stigmatised and discriminated in developed countries than developing countries where the impact is hardest hit. Moreover, preliminary results from the People Living with HIV Stigma Index found that 17 percent of respondents living with HIV in the some developed countries had been denied health care and that verbal harassment or assault had been experienced by 21 percent of respondents.

Stigma may also vary depending on the dominant transmission routes in the country or region. In sub-Saharan Africa, for example, heterosexual sex is the main route of infection, which means that AIDS-related stigma in this region, is mainly focused on promiscuity and sex work. Since most of the time transmission of HIV/AIDS is linked to be about sex in our communities most people then automatically think everyone might have gotten it because s/he might have been loose or are not anything better than a prostitute as they don't believe someone can't get it any other way. This statement clearly illustrates the multi-layered nature of stigma. In Western countries where injecting drug use and sex between men have been the most common sources of infection hence it is these behaviours that are highly stigmatised. Stigma and discrimination has also been known to take particular forms within key populations at higher risk. For example, studies have shown that within some gay communities there is segregation between HIV-positive and HIV-negative men, where men associate predominately with those of the same status. Some people living with HIV have linked this 'rift' within the community with depression, anxiety and loneliness. Other members of gay communities have reported stigma based on physical changes due to the side effects of treatment, which can lead people to delay seeking and initiating treatment.

In the majority of developing countries families are the primary caregivers when somebody falls ill. There is clear evidence that families play an important role in providing support and care for people living with HIV and AIDS. However, not all family responses are supportive. HIV positive members of the family can find themselves stigmatised and discriminated against within the home. There is concern that women and non-heterosexual family members are more likely than children and men to be mistreated.

Stigma also worsens problems faced by children orphaned by AIDS. AIDS orphans may encounter hostility from their extended families and community, and may be rejected, denied access to schooling and health care, and left to fend for themselves. AIDS-related stigma can lead to discrimination such as negative treatment and denied opportunities on the basis of their HIV status. This discrimination can affect all aspects of a person's daily life, for example, when they wish to travel, use healthcare facilities or seek employment.

A Dutch survey of people living with HIV found that stigma in family settings in particular indicated that avoidance exaggerated kindness and being told to conceal one's status to have a significant predictor of psychological distress. This was believed to be due to the absence of unconditional love and support, which families are expected to provide. Furthermore, people living with HIV are often worried about losing family and friends if they disclose their status. As a global study illustrated, 35 percent of those interviewed cited this as a concern surrounding disclosure. Research by the International Centre for Research on Women (ICRW) found the possible consequences of HIV-related stigma to be: Loss of income/livelihood, Loss of marriage & childbearing options, Poor care within the health sector, Withdrawal of caregiving in the home, Loss of hope & feelings of worthlessness and Loss of reputation. Some of these consequences refer to 'internal stigma' or 'self-stigma'. Internal stigma refers to how people living with HIV regard themselves, as well as how they see public perception of people living with HIV. Stigmatising beliefs and actions may be imposed by people living with HIV themselves. Self-stigma and fear of a negative community reaction can hinder efforts to address the AIDS epidemic by perpetuating the wall of silence and shame surrounding the epidemic. The eventual outcome of the AIDS epidemic is decided within the community.

To win the fight against stigma and discrimination related to HIV/AIDS, people and institutions ultimately should decide whether to adapt their sexual, economic and social behaviour to the threat of epidemic. They are the subjects of the response to AIDS, not merely the objects of outside interventions. Therefore, responses to HIV are in the first instance local that is to imply the involvement of people where they live in their homes, their neighbourhoods and their workplaces. Community members are also indispensable for mobilizing local commitment and resources for effective action. In particular, people living with HIV/AIDS must play a prominent role and bring their unique experience and perspective into programmes, starting from the planning stage. Community mobilization against HIV/AIDS is taking place successfully all over the world. The activities carried out in community projects are as diverse as the peoples and cultures that make up these communities. Some are entirely 'home-grown' and self-sufficient, while others have benefited from external advice and funding. Some are based in religious centres, others in medical institutions, and still others in neighbourhood meeting places. Many concentrate on public education, others on providing care, and still others on prevention and other goals. The virtues of civilization are incompatible with civic virtues and the resurgence of homosexuality in this modern day and age poses a huge challenge towards the fight against the epidemic as gay couples are more prone to HIV infection due to the receptacle used as sexual contact. However, an amicable solution needs to be arrived at in helping such individuals spiritually or medically as sending them to jail only worsens the behaviour since prisons are known for most men getting sexually assorted or women. Some prison centres need so much to be desired as re-correction facilities especially in developing countries like Zambia.

FOR COMMENTS & QUESTIONS
JONES. H. MUNANG'ANDU (author)
Motivational speaker, health commentator &
Health practitioner
Mobile; 0966565670/0979362525
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