September 5, 2001
"HIV-related stigma and discrimination remain an immense barrier to effectively fighting the most devastating epidemic humanity has ever known," said Dr Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "If HIV-related stigma and discrimination are not tackled, AIDS will blight the 21st century just as racism affected the 20th century."
Fear of discrimination may prevent people from seeking treatment for AIDS or from acknowledging their HIV status publicly. People with, or suspected of having, HIV may be turned away from health care services, denied housing and employment, shunned by their friends and colleagues, turned down for insurance coverage or refused entry into foreign countries. In some cases, they may be evicted from home by their families, divorced by their spouses, and suffer physical violence or even murder. The stigma attached to HIV/AIDS may extend into the next generation, placing an emotional burden on children who may also be trying to cope with the death of their parents from AIDS.
"HIV thrives on intolerance and xenophobia. It is always easier to blame others for the spread of HIV but progress against the epidemic is only possible when communities own the problem of AIDS themselves," Dr Piot said.
Denial goes hand in hand with discrimination, with many people continuing to deny that HIV exists in their communities. Social taboos about sexuality may prevent open discussion and effective prevention education. Many people do not know they are HIV-positive and are afraid to be tested because of the stigma attached to seropositivity.
In most countries, AIDS was first perceived as a "disease of outsiders," imported by foreigners. This fed on racism, breeding xenophobia. The resulting social exclusion cuts off individuals and communities from one another. This exclusion in turn engenders lack of involvement and social inaction, leaving individuals sheltering behind a wall of silence and preventing the social mobilisation that has proved the most effective tool in fighting the epidemic.
AIDS, poverty and racism are mutually reinforcing. Vulnerability to HIV/AIDS is linked to social exclusion caused by poverty and racism.
"People with HIV/AIDS from minority ethnic groups are often blamed for their condition. They are viewed as causing their own misfortune rather than as individuals suffering from marginalization and inequality," Dr Piot said.
Dr Piot was speaking at the launch of the "UNAIDS Compendium on Discrimination, Stigmatization and Denial," a set of reports that use case studies from India and Uganda to explore HIV-related discrimination, stigma and denial. The launch was held during the World Conference against Racism, Racial Discrimination, Xenophobia and Related Intolerance, which is taking place in Durban, South Africa from 31 August-7 September.
The reports found significant levels of discrimination, including in health care settings, although in Uganda there was evidence of 'normaliziation' of HIV in health care settings and workplaces resulting in people with HIV being responded to more positively. Stigma and discrimination caused inheritance, care giving and housing to be particular problems for women. Schools, insurance companies and funeral services were also found to be places where discrimination occurred. Religious leaders gave inconsistent messages about attitudes to people with HIV, and greater attention was needed to create enforceable laws to protect people with HIV. People in marginalized groups were found to suffer double doses of discrimination, resulting from fear of HIV together with the reinforcement of already existing discrimination.
"We must continue to encourage people to break the silence and to combat the stigma attached to HIV/AIDS," Dr Piot said. "Combating stigma is essential to break the vicious cycle that links AIDS to poverty, racism and gender inequality."
HIV/AIDS has caused a major development crisis in sub-Saharan Africa, and is making deep inroads into economic and social development in Asia, Latin America, the Caribbean and Eastern Europe. In subsistence agriculture, labour shortages and declining incomes because of AIDS deaths are changing the way people farm and compounding food insecurity. Among poor households, people may be unable to seek treatment for sexually transmitted infections which, left untreated, increase the risk of contracting HIV, the virus that causes AIDS. Poverty may push young people and women into unprotected commercial sex to provide for their families. At the same time, one of the consequences of HIV/AIDS is greater poverty as individuals, families and communities lose productive labour as well as face escalating health and funeral costs.
The interaction between gender and race renders women of colour especially vulnerable in the face of the epidemic. While education can help protect against infection through information on prevention and by helping women take control over their lives, women from disadvantaged racial, ethnic, immigrant and indigenous communities have less access to education than other groups and are therefore doubly disadvantaged.
Today, HIV/AIDS threatens the welfare and well-being of people throughout the world. At the end of last year, 36.1 million people were living with HIV or AIDS, and 3 million died from AIDS-related illnesses. While the majority of infections are in sub-Saharan Africa - 25.3 million, the epidemic is intensifying in many other parts of the world.
For more information, please contact Anne Winter, UNAIDS, Geneva, (+41 22) 791 4577, Dominique de Santis, UNAIDS, Geneva, (+41 22) 791 4509, Richard Delate, UNAIDS, Durban, cell: (+2782) 370 2666 or Andrew Shih, UNAIDS, New York, (+ 1 212) 584 5024.