Bertrand Audoin is the Executive Director of the International AIDS Society (IAS) and a member of the Stigma Action Network's Steering Committee. He has been working in the HIV field for almost 20 years, and first became involved in the response to the epidemic at grass roots level in the early 1990s. For more information about Bertrand read his full IAS bio here.
Given that the International Congress on AIDS in Asia and the Pacific (ICAAP11) – in
is soon upon us I’d like to do a follow up to the New
York Times opinion piece I wrote a few months ago on the impact of
homophobic laws and discrimination following the recent murders of a
transgender youth and a gay man. Bangkok
The issues of stigma and discrimination can also be deeply felt in health care settings too. People are more likely to use health services if they are confident that they will not face discrimination; that their use of services will not expose them to other risks, such as detention due to their criminalized status; that their confidentiality will be maintained; that they will have access to information; and that they will not be coerced into accepting services without consent.
Many reports reveal the real existence of the discrimination that many people living with HIV/AIDS experience in health-care systems, including differential treatment; the denial of treatment; HIV testing without consent; breaches of confidentiality and refusal of treatment – refusal to provide medical services to people living with HIV.
Women living with HIV/AIDS experience double discrimination in health-care settings. Reports indicate that pregnant women are routinely tested for HIV without their knowledge, much less informed consent to the procedure.
of all HIV-positive men are advised, and sometimes forced, to undergo HIV
testing whether seeking medical care or not. HIV testing is also administered
as a rule to all patients prior to surgery and in cases where a suspicion of
HIV arises based on their physical appearance or belonging to a high-risk
group, such as sex workers. Generally, such testing is mandatory, no consent is
provided and there is no pre- or post-test counseling.
It is truly unacceptable that reports are still revealing that 29% of persons living with HIV/AIDS in
India, 38% in Indonesia
and over 40% in Thailand
say that their HIV-positive status had been revealed to someone else without
This stigma and discrimination towards people with HIV can lead to a vicious cycle with well documented negative health implications ranging from increased depressive symptoms to engaging in risky sexual behaviour.
We’ve long known that there are three main causes of HIV-related stigma in health facilities: a lack of awareness among health workers of what stigma looks like and why it is damaging; fear of casual contact stemming from incomplete knowledge about HIV transmission; and the association of HIV with improper or immoral behaviour.
At the IAS we strongly believe that HIV professionals, whatever their level and field of engagement and action, can play a pivotal role in breaking down barriers and contributing to achieving universal access through a human rights framework. They are a key entry point for promoting and implementing change and preventing situations of abuse and dysfunction in a wide range of settings
The IAS has a two pronged approach to its work with HIV professionals: ensuring that health care providers and HIV professionals are aware of their own human rights AND enabling HIV professionals to realize rights based approaches and attitudes in all work they undertake both in and outside of provide health care settings.
The IAS also aims to equip HIV professionals with the skills and tools necessary to ensure patients’ rights to informed consent, confidentiality, treatment and non-discrimination and to also build their ‘legal literacy’ by improving their knowledge of human rights and the national and local laws relevant to HIV.
I am convinced that building both the knowledge and capacity of HIV professionals will empower them to become agents of change and enable them to provide the highest available standard of care to people living with, affected by and at higher risk of becoming infected with HIV.
forward to my colleagues at
the Stigma Action Network reporting back on their own workshop at ICAAP 11 as
well as their impressions of the more generalized discussions around the issue
at the conference.