HIV Stigma and Discrimination - by Johan Obbes

A huge part of the South African government’s new ACTS program which is to replace the current Voluntary Counselling and Testing system, will address one of the biggest obstacles in our fight against HIV/Aids…Stigma and Discrimination. This makes us think, how many times do we actually create a system which actually contributes to the very problem it is meant to curb.

It is so easy for us to create an in-group and an out-group in every sector of life, religion, culture, language, sexuality, race and illness, yet we don’t always realise that this classification of groups are the very thing that breeds stigma. Currently HIV testing is associated with clients going into a specific demarcated room in most clinics and hospitals, which highlights the question – Why do we separate HIV testing from other screening tests? It is in fact just another chronic disease!

AIDS-related stigma and discrimination remain the greatest obstacles to people living with HIV infection or AIDS. Stigma and discrimination increase people’s vulnerability, isolate them, deprive them of their human rights, care and support, and worsen the impact of infection. Stigma and concerns about discrimination are the main reason why people do not come forward to have an HIV test, to access antiretroviral drugs, to adopt safe feeding methods for their babies, or to change high-risk sexual behaviour.

But stigma and discrimination do not arise in a vacuum. They emerge from and reinforce other stereotypes, prejudices and social inequalities relating to gender, nationality, ethnicity and sexuality. They also feed into activities that are criminalised such as sex work, drug use or even sex between men. “Stigma, discrimination and human rights violations form a vicious circle, legitimising and spurring each other” (UNAIDS, 2002:67):

The following efforts should be implemented worldwide to fight stigma and discrimination (UNAIDS 2002:67).

-      Leaders at all levels and in all walks of life should be encouraged to visibly challenge and act against the many forms of HIV-related discrimination and to spearhead public action.

-      People living with HIV/AIDS should be actively involved in the response to the epidemic.

-      Violations of human rights should be monitored, people should be able to challenge discrimination, and institutions should be designed to safeguard human rights.

-      Governments should take urgent action to protect women’s property and inheritance rights, and to protect children against sexual exploitation.

-      A legal environment able to support the fight against discrimination should be created.

-      Prevention and treatment, care and support services should be accessible to all.

By showing their own support and responsibility to care for all people, regardless of their health or social status, health care professionals can act as role models for others in helping to combat stigma, discrimination and the isolation of people living with HIV/Aids. Prevention strategies will become far more successful if and when HIV is treated like any other disease, and when people feel safe to be open about their HIV status. However, health  care professionals can become advocates for acceptance and care only if they look inward and first examine their own beliefs, values, assumptions and attitudes towards HIV/Aids This can be done individually or in groups by asking and reflecting on the following questions (WHO, 2000a:6-5)

-      What fears of misunderstandings do I have?

-      How might these fears or misunderstandings affect my work?

-      Where do these fears or misunderstandings come from?

-      How can I overcome these fears or misunderstandings in order to provide care, support, counselling, education, and advice in the prevention and care of HIV/Aids?

-      What influence do I have on others who care for people infected and affected by HIV/Aids?

-      What is my role in providing and promoting safe, moral and ethical care to people living with HIV and their loved ones, caregivers and communities?

Health care professionals should also think about and listen to the “language” they use when they speak: prejudiced language may alienate them from their target group. While saying “He caught AIDS” and “He has AIDS” may mean the same thing, the first sentence is loaded with negative meanings that betray the implicit attitudes of the speaker. (Such negative meaning may be that AIDS is something over which we the, innocent, have no control, something that we “catch” from “them” – the contaminated “others”.) People often say “He is HIV” instead of “He is HIV positive”. A sentence constructed like this implies an identity with the virus, i.e. the person is the virus, instead of the person has the virus.

AIDS educators should always be careful not to use sexist language. Always to refer to he and him in the context of HIV/Aids may imply that men are always the “guilty” party. Victimising language should also be avoided. “She suffers from AIDS” one should rather say “She lives with AIDS” or “She is HIV positive”. Rather than referring to “rape victims” use positive language and refer instead to “rape survivors”. Be careful not to fall in the trap of using prejudiced or discriminatory language. If you refer to people with HIV infection as “those people”, you are clearly dividing the world into two groups: the innocent, healthy us, and the guilty diseased them.

While we all sometimes thing in terms of stereotypes, we should make every effort to be aware of our own stereotypes so that we can root them out and thus avoid offending others and hurting feelings. If we interact with members of a stereotyped group, we will quickly learn to recognise our own prejudices and eliminate them. The irrational and often exaggerated fears associated with HIV/Aids can be directly addressed through educational programmes base on sound medical, social and psychological knowledge. To be successful, such programmes must be sustained and supported over time. Prevention strategies will continue to be compromised if fear, ignorance, intolerance and discrimination against HIV-positive people persist. Health care professionals have a responsibility to help “normalise” HIV in the communities where they work so that modes of transmission and prevention can be addressed without the emotional and attitudinal values that are currently getting in the way of open dialogue. Counsellors and other health care professionals should not only advocate for Universal Precautions, but also for universal tolerance and knowledge about HIV/Aids.

Having said all this, we should challenge ourselves with some introspection by asking – How much do I really know about HIV/Aids? Or better yet – Am I contributing to the stigma or am I contributing to the solution?


Written by Johan Obbes - Exerts from this article was taken from 'HIVAIDS Care & Counselling, A multidisciplinary Approach; Alta van Dyk, Fourth Edition'