HIV/AIDS stigma and discrimination (II)
Bilyaminu Haruna Mohammad
bhmohammad009@gmail.com
Gsm:08022416012
Women with HIV or AIDS may be treated very differently from men in some societies where they are economically, culturally and socially disadvantaged.
They are sometimes mistakenly perceived to be the main transmitters of sexually transmitted diseases (STDs).
Men are more likely than women to be 'excused' for the behaviour that resulted in their infection.
"Even a married woman who has been infected by her husband will be accused by her in-laws.
In such a male-dominated society no-one ever accepts that the man is actually the one who did something wrong.
It is even harder on women since it is seen as a fair result of their sexual misbehaviour.
Nevertheless, some people have to contend with stigma even before their HIV status is confirmed.
There is no douht, older people for example, are sometimes seen as part of a non-economically productive community who consume resources without contributing.
However, older people living with HIV may therefore have a double burden.
The effects of stigma
In This epidemic of fear, stigmatization and discrimination has undermined the ability of individuals, families and societies to protect themselves and provide support and reassurance to those affected.
This hinders, in no small way, efforts at stemming the epidemic.
It complicates decisions about testing, disclosure of status, and ability to negotiate prevention behaviours, including use of family planning services.
AIDS-related stigma has had a profound effect on the epidemic’s course.
The WHO cites fear of stigma and discrimination as the main reason why people are reluctant to be tested, to disclose HIV status or to take antiretroviral drugs.
These factors all contribute to the expansion of the epidemic as a reluctance to determine HIV status or to discuss or practice safe sex means that people are more likely to infect others and a higher number of AIDS-related deaths.
An unwillingness to take an HIV test means that more people are diagnosed late, when the virus has already progressed to AIDS, making treatment less effective and causing early death.
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 and child bearing options
• Poor care within the health sector.
• Withdrawal of care giving in the home.
• Loss of hope and feelings of worthlessness.
• Loss of reputation Some of these consequences refer to ‘internal stigma’ or ‘self-stigma’.
Internal stigma refers to how someone with HIV thinks about themselves and how they believe that the public perceives someone with HIV.
However, people living with HIV/AIDS, may impose stigmatizing beliefs and actions on themselves:
They would say “I am afraid of giving my disease to my family members—especially my youngest brother who is so small.
It would be so pitiful if he got the disease.’’
He would say I am aware that I have the disease so I do not touch him—I talk with him only. I don’t hold him in my arms now.’’
Report also indicate that 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.
Stigma also exacerbates 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.
The widespread fear of stigma is held accountable for the relatively low uptake of prevention of mother-to-child transmission (PMTCT) programmes in countries where treatment is free.
In the case of Botswana, for example, despite the fact that the service is available at every antenatal centre in the country, only 26% of pregnant women availed themselves of the opportunity to protect their unborn children.
Over half refuse to take a test, and nearly half of those who tested positive did not go on to accept treatment.
Types of HIV/AIDS-related stigma and discrimination
Meanwhile, AIDS-related stigma can lead to discrimination towards people living with HIV/AIDS.
AIDS-related discrimination means that people are treated negatively and denied opportunities on the basis of their HIV status.
This discrimination can occur at all levels of a person’s daily life, for example, when they wish to travel, use healthcare facilities or get a new job.
Nevertheless government that has laws, rules and policies regarding HIV/AIDS can have a significant effect on the lives of people living with HIV/AIDS. Discriminatory practices can alienate and ostracise PLWHA, reinforcing the stigma surrounding the disease.
In 2008, UNAIDS reported that 67% of countries now have some form of legislation in place to protect PLWHA from discrimination.
However, Ban Ki-moon, Secretary-General of the United Nations, believes that ‘almost all permit at least some form of discrimination’.
There are many ways that governments can actively discriminate against people or communities suspected of having HIV/AIDS.
Below are some examples of government level stigma and discrimination against people living with HIV/AIDS:
• The USA, Armenia, Brunei, China, Iraq, South Korea, Moldova, the Russian Federation and Saudi Arabia restrict people with HIV/AIDS from entering their country.
• President Museveni of Uganda supports the national policy of dismissing or not promoting members of the armed forces who test HIV positive.
• The Chinese government advocates compulsory HIV testing for any Chinese citizen who has been living outside of the country for more than a year.
• The UK legal system can prosecute individuals who pass the virus to somebody else, even if they did so without intent.
• The United Arab Emirates (UAE) immediately deports any expatriates with HIV/AIDS.
Healthcare
The withholding of treatment, hospital staff refusing to treat patients, HIV testing without consent, lack of confidentiality, and denial of hospital facilities and medicines are all ways that PLWHA can experience stigma and discrimination in healthcare settings.
Such responses are often fuelled by ignorance of HIV transmission routes amongst doctors, midwives, nurses and hospital staff.
Lack of confidentiality has been repeatedly mentioned as a particular problem in health care settings.
Many people living with HIV/AIDS do not get to choose how, when and to whom to disclose their HIV status.
Studies by the WHO in India, Indonesia, the Philippines and Thailand found that 34% of respondents reported breaches of confidentiality by health workers.
Doctors in healthcare setting in resource-poor areas with limited or no drugs have reported a frustration with the lack of options for treating people with HIV/AIDS, who were seen as 'doomed' to die.
This frustration may mean that AIDS patients are not prioritised or are actively discriminated against.
Fear of exposure to HIV as a result of lack of protective equipment is another factor fuelling discrimination among doctors and nurses in under-resourced clinics and hospitals.
Studies also shows that stigma and discrimination in healthcare settings are not confined to developing countries.
Employment
In the workplace, PLWHA may suffer stigma from their co-workers and employers, such as social isolation and ridicule, or experience discriminatory practices, such as termination or refusal of employment. Fear of an employer’s reaction can cause a person living with HIV anxiety:
"It is always in the back of your mind, if I get a job, should I tell my employer about my HIV status? There is a fear of how they will react to it. It may cost you your job, it may make you so uncomfortable it changes relationships.
‘’Yet you would want to be able to explain about why you are absent, and going to the doctors,’’ said PLWHA.
Though, community-level stigma and discrimination can manifest as ostracism, rejection and verbal and physical abuse. In extreme circumstances it has extended to acts of violence and 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.
Family
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 PLWHA.
However, not all family responses are positive. HIV-infected 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.