Breaking Down Barriers: Addressing HIV Stigma in Health Care Settings by Betrand Audoin, Executive Director of the IAS

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.

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Given that the International Congress on AIDS in Asia and the Pacific (ICAAP11) – in Bangkok 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. 

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.

In India, spouses 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 their consent.

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.

I look 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.