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More than 25 years into the HIV/AIDS epidemic, scientific advances are helping HIV-positive people live longer. But some of the same problems that existed in the early days of the epidemic continue today, such as stigma and discrimination.
The growing use of anti-retroviral drugs has improved the quality and longevity of the lives of people infected with the AIDS virus, HIV. But Paul Perchal, president of the reproductive health organization EngenderHealth, says the drugs do not treat stigma and discrimination.
"A lot of people think, for example, that stigma will go away once you've scaled up treatment and care services. But in actuality that doesn't always happen, and stigma and discrimination are still very prevalent in most countries around the world and it's still contributing to the spread of HIV," he said.
Stigma and discrimination go hand in hand, with one fueling the other.
He says, "Stigma refers to the beliefs and attitudes that deeply discredit a person or a group because of an association with HIV. This leads to discrimination, including actions or omissions that harm people or deny services or rights for stigmatized individuals. And stigma and discrimination are particularly harsh for populations already socially excluded or that do not have equal status in society, such as women."
United Nations and health officials say women and girls are much more vulnerable to HIV/AIDS than men and have borne the brunt of the epidemic.
"Heterosexual women, for example, are more prone than men to being abandoned and gender-based violence. Their partners find out that they are HIV positive. They generally have limited access to information about HIV and AIDS. And they're often denied HIV services, initially because they weren't perceived as a risk group. So, even if they were at a healthcare facility, they weren't necessarily offered an HIV test. And for women who are HIV positive, it's often because of stigmatizing attitudes and practices of health providers," he says.
Perchal says the problems women face have root causes common around the world.
"The three root causes are a lack of awareness and knowledge of HIV-related stigma and discrimination, fear of acquiring HIV through everyday contact with people living with HIV, and a tendency to link people living with HIV to behaviors considered improper and immoral," he says.
EngenderHealth operates programs on various levels of society where stigma and discrimination exist. One example is Ghana.
"So, in Ghana, through a program called Community Health Partners, EngenderHealth is scaling up its efforts to address stigma and discrimination at 25 public hospitals and clinics across all 10 regions of Ghana, covering more than 75 percent of all the clients receiving ARV (anti-retroviral) treatment. We're also collaborating with other partners to address stigma at the community level through BCC activities and the involvement of community leaders," he says.
The phrase "BCC" activities means "behavioral change communication." The goal of BCC is to dispel myths about HIV/AIDS. The activities include sensitivity training for healthcare workers and supportive environments for those living with HIV/AIDS. EngenderHealth integrates HIV/AIDS care with primary health services, such as family planning.
EngenderHealth says the fact that people with HIV/AIDS are now living longer with the help of new medicines signals and era of hope. But it also signals an new era of challenges.