UNAIDS has released a new report showing how stigma and discrimination is creating barriers to accessing HIV prevention, testing and treatment services and putting lives at risk.
The report, Confronting discrimination: overcoming HIV-related stigma and discrimination in health-care settings and beyond, was launched by the Executive Director of UNAIDS, Michel Sidibé, during the Human Rights Council Social Forum. It shows that people living with HIV who experience high levels of HIV-related stigma are more than twice as likely to delay enrolment into care than people who do not perceive HIV-related stigma.
“When people living with, or at risk of, HIV are discriminated against in health-care settings, they go underground. This seriously undermines our ability to reach people with HIV testing, treatment and prevention services,” said Mr Sidibé. “Stigma and discrimination is an affront to human rights and puts the lives of people living with HIV and key populations in danger.”
Often, people living with HIV avoid going to clinics for fear of having their status disclosed or of suffering further stigma and discrimination based on their HIV status. Across 19 countries with available data, one in five people living with HIV avoided going to a clinic or hospital because they feared stigma or discrimination related to their HIV status. When people living with HIV wait until they are very ill before seeking help, they are less likely to respond well to antiretroviral therapy. Read the press release via UNAIDS
Irrational fears of HIV infection and negative attitudes and judgements towards people living with HIV persist despite decades of public information campaigns and other awareness-raising efforts. Populations at increased risk of HIV infection face high levels of stigma due to, among other things, their gender, sexual orientation, gender identity, drug use or sex work. Stigma towards people living with or at risk of HIV drives acts of discrimination in all sectors of society—from public of cials, police of cers and health-care workers to the workplace, schools and communities. In many countries, discriminatory laws and policies reinforce an environment of violence and marginalization. This stigma and discrimination discourages people from accessing health-care services, including HIV prevention methods, learning their HIV status, enrolling in care and adhering to treatment.
Studies on stigma and discrimination and health-seeking behaviour show that people living with HIV who perceive high levels of HIV-related stigma are 2.4 times more likely to delay enrolment in care until they are very ill (1). In eight countries with available data, more than a quarter of people living with HIV reported that they had avoided going to a local clinic in the previous 12 months because of their HIV status (Figure 1) (2). Such fears also discourage the uptake of prevention and testing services. For example, fear of the HIV-related stigma and discrimination that may result from an HIV-positive test result and having that result disclosed to others, either through self-disclosure or otherwise, has been identi ed as a disincentive to HIV testing in a range of settings (3, 4).
In 2015, the global community committed to ending the AIDS epidemic as a public health threat by 2030 as part of the 2030 Agenda for Sustainable Development. It is an ambitious yet achievable goal. Scale-up of the most effective services for preventing HIV infection and treating people living with HIV has already seen a 32% global decline in AIDS-related deaths and a 16% global decline in new HIV infections between 2010 and 2016; and 2016 also marked the rst time more than half (53% [39–65%]) of all people living with HIV were accessing antiretroviral therapy (5). Yet these gains are not distributed equally, and groups that face discrimination are often left behind—in many cases in fear of or facing discrimination, which drives them further away from accessing the services they need. Putting the world on track to ending AIDS as a public health threat by 2030 requires a persistent global effort to eliminate HIV-related stigma and discrimination alongside wider efforts to address marginalization and exclusion in health care.
This report compiles the latest body of evidence on how stigma and discrimination create barriers across the HIV prevention, testing and treatment cascades and reduce the impact of the AIDS response. The report also brings together best practices on confronting stigma and discrimination, providing a valuable resource for programme managers, policy-makers, health-care providers and communities. The evidence shows that the establishment of people-centred service delivery models, supportive legal and policy frameworks, monitoring and enforcement mechanisms, and sensitization training for health-care workers and other duty bearers can promote inclusion and increase access to services.