Tackling Discrimination

With respect to measures to counter discrimination, a programmatic approach has frequently been adopted. This has involved a variety of actors coming together to counter the negative consequences of HIV/AIDS-related stigma on lives and communities.

In India, for example, the Lawyers' Collective in Mumbai has successfully defended workers who have been discriminated against and lost their jobs on account of their HIV-positive status. The collective has also raised public awareness about HIV/AIDS through public rallies, and it mobilizes public opinion against stigma and discrimination. One of its most significant achievements to date has been the upholding of the 'suppression of identity' clause. This allows a person with HIV/AIDS to file his or her case under a pseudonym¹.

Also in India, work is under way in New Delhi to establish HIV-patient-friendly hospitals. The goal is to make services more attuned to the needs of people with HIV/AIDS. Among the measures being taken is policy development on matters such as pre- and post-test counselling, confidentiality and the importance of informed consent. Efforts are also being made to extend staff education and training, and to strengthen the application of universal precautions in patient care².

In Thailand, the Thai Business Coalition, which comprises around 125 businesses, including multinational companies, has developed training courses and a manual to support good workplace policy and practice. Documented effects of this work include HIV-positive employees reporting increased levels of acceptance and support, human resource personnel requesting technical assistance in the development of non-discriminatory policies, and staff volunteering to participate in the work of HIV/AIDS NGOs and/or specific HIV/AIDS projects³.

The Brazilian subsidiary of Unilever has reinforced the company's internationally adopted HIV/AIDS response with an HIV/AIDS programme focused not just on employees, but also on their families and the community. The company used one of its brands -- the AXE deodorant -- to identify a campaign promoting greater awareness and acceptance among 14-25-year-old men. The company subsequently used the platform of the Brazilian Business Council for HIV/AIDS to share their experience and materials with other companies⁴.

In South Africa, the Centre for the Study of AIDS at the University of Pretoria has been active in challenging racist and prejudiced attitudes among staff and students. The centre has also introduced HIV/AIDS-related concerns into elements of the higher education curriculum, including in subjects such as law, agriculture and engineering. This has led to greater understanding of the issues, de-stigmatizing and enhancing discussion of HIV/AIDS-related concerns⁵. Also in South Africa, the AIDS Law Project at the University of Witwatersrand has challenged HIV/AIDS-related discrimination in the highest-level courts, on issues such as unfair dismissal and discrimination in prisons⁶.

Lack of access to antiretroviral treatment is a key issue that enhances or advances HIV/AIDS-related stigma and discrimination in many countries. The perceived 'untreatability' of AIDS is a key factor contributing to the stigmatization of many of those affected. As long as HIV/AIDS continues to be equated with serious illness and death, public attitudes towards the epidemic seem likely to be slow to change. For this reason, as well as on the grounds of equity and justice, efforts are being made to extend the availability of antiretroviral drugs.

In Costa Rica, for example, where official resistance to antiretroviral therapy was initially premised on the assumption that it was too expensive to provide, a small group of people living with AIDS -- the Patient Coalition -- negotiated for a year with the government. Frustrated, the group appealed to the Supreme Court in 1997 and won its support, forcing the government to begin offering antiretroviral drugs to people with HIV/AIDS. Today, a substantial number of Costa Ricans with AIDS receive combination therapy⁷. Just as importantly, the increasing visibility of people with HIV/AIDS in this country and in other Central American republics is helping to significantly enhance awareness and challenge negative stereotypes and attitudes⁸.

In Venezuela, Acción Ciudadana Contra el Sida (ACCSI) filed a suit on behalf of 11 people with HIV/AIDS who claimed they were not receiving proper medical attention, and their rights to non-discrimination, health, equality, access to science and technology and access to social security, as guaranteed by the National Constitution, the American Convention on Human Rights, and other conventions signed and ratified by Venezuela, were thereby being infringed. In May 1997, the court upheld the lawsuit, and ordered the social security system to provide treatments (including protease inhibitors) on a regular basis at no cost. Numerous other lawsuits have subsequently been successful, including those filed against the Ministry of Defence and the Ministry of Health⁹.

In Brazil, the government, pushed by a strong activist movement, has instituted free HIV/AIDS treatment for everyone who needs it. Today, almost all people in Brazil have access to treatment, and mortality from AIDS has been substantially reduced. Aggressive policies combining parallel licensing and successful negotiations with pharmaceutical companies for sharp price reductions have contributed to the success. But there have been social consequences, as well. Brazil's response to HIV/AIDS has been recognized as one of the most successful globally and, while HIV/AIDS-related social solidarity cannot be solely attributed to the availability of treatment drugs, the widespread availability of such drugs has reportedly lessened negative responses to the epidemic¹⁰.

But even in countries with well-developed treatment-access programmes, the risk of discontinuation and interruption of treatment availability continues to be a concern. In Argentina, and in the wake of the serious economic problems currently confronting the country, the vulnerability of the antiretroviral-treatment-access programme has been highlighted. Here, as in other countries, there is serious concern that the distribution of medication may be in jeopardy because of the broader political and economic situation¹¹.

Notes

1. www.hri.ca/partners/lc/about/cases.shtml.
2. www.popcouncil.org/horizons/projects.html.
3. UNAIDS (1997) The Business Response to HIV/AIDS. Innovation and Partnership. Geneva, UNAIDS.
4. www.businessfightsaids.org/.
5. www.csa.za.org/.
6. www.serverlaw.wits.ac.za/cals/alp/index.shtml.
7. www.aegis.com/news/panos/1998/PS980901.html.
8. www.aguabuena.org/ingles/articulos.html.
9. www.aidslaw.ca/Maincontent/otherdocs/
   Newsletter/vol5no42000/carrascodurban.htm.
10. Ministry of Health Brazil (2000) The Brazilian Response to AIDS. Brasilia DF, Ministry of Health. See also www.unaids.org/bestpractice/digest/files/brazilianresponse.html.
11. Personal communication, V. Terto Jr, ABIA, Rio de Janeiro, Brazil. www.unaids.org/acc_access/index.html.