HIV/AIDS in its Second Decade: Stigma and Death
Stigma and Discrimination: The Role of Treatment Access -- Report From the IAS Conference, Paris
August 12, 2003
Stigma causes fear and shame. It breeds hate and discrimination, which causes death. People living with HIV or AIDS live with stigma in every society of the world and die with it far sooner than they would have died without it, in other words: Stigma kills.
Stigma keeps people from being tested, receiving treatment, caring for their neighbors. It binds prevention efforts and renders them useless. It prevents people from receiving care inside their communities and allows them to die alone, shunned. Stigma creates households headed by eight-year-olds who are struggling to care for 5-year-olds and infants. Left on their own, children orphaned by stigma are denied their place in a loving community, their right to receive the food, shelter and education needed to grow into productive adults.
One measure of stigma is how willing or not people with HIV or AIDS are to be open about their status. Being HIV positive and open about it, in many areas, results in being shunned by your family, your peers, your community, your government. Being openly positive more often than not results in poverty, starvation, more disease, and early death. From the US to South Africa to India and beyond, openness has resulted in murder. Faced with such atrocity, most people go to great lengths to hide their status, so much so that partners hide their status from each other and women would rather expose their infants to the risks of contracting the disease than the risk of all the above.
Every one of us would like to think that we would behave better than that to our fellow human being, but fear is a quirky thing. Would we? Do we?
Another measure is whether people who do not yet know their status are willing to find out. There are millions of people who are HIV positive and do not know it. Fear of stigmatization keeps them from being tested. Why bother when there is no treatment and your life will be transformed for the worse just by knowing?
According to evidence presented at the IAS conference, many of the aspects of stigma are alleviated by having treatment available to those who need it. When prevention of perinatal transmission first became a reality, the number of pregnant women who underwent VCT rose dramatically. MSF and others presented data demonstrating when treatment for HIV was offered, people came in for care earlier, VCT use rose, community involvement increased, and people who were positive reported being more willing to use condoms, educate others, and form support groups.
Treatment offers hope, and hope is a lance for the stigma canker.
So why aren't the millions of people world wide who need treatment not receiving it? The answer is stigma of another sort: discrimination by governments who are not invested in the welfare of their people and by donor countries that don't see political advantage in investing in the poor and disenfranchised. The developed world discriminates against the developing one in a way that increases an already unimaginable disparity. This is stigma and discrimination on a global scale. Shame, indeed.
As Nelson Mandela said in his address to the conference delegates, AIDS is the biggest health crisis in human history and we have failed in our quest to contain it. We have failed to "translate science into action" where it is most needed, meaning that the rich refuse to subsidize the poor although a mere $3 from every person in a rich country would fill the Flobal Fund's empty well.
Such North-South discrimination has resulted in a magnitude of injustice and a failure of human rights that is increasingly ill tolerated. When our grandchildren ask, what will we be able to tell them we did right these wrongs?
This article was provided by Seattle Treatment Education Project. It is a part of the publication STEP Ezine.