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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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.
