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In 2010 alone, Aids killed 1,8 million people, 1,2 million of whom were living in sub-Saharan Africa.
According to the latest Zimbabwe Demographic Health Survey (ZDHS) of 2010-2011, there are 1,3 million people in the country who are living with HIV and Aids of which 151 749 are children. Almost half of those are eligible for antiretroviral drugs while 593 168 are already on antiretroviral treatment (ART).
The National Aids Council (Nac)’s chief executive officer, Dr Tapuwa Magure, said Zimbabwe has made great strides in the fight against HIV and Aids over the last five years, resulting in a sharp decline in the prevalence rate from 21 percent to 13,7 percent last year.
He however, noted that despite a significant drop in the HIV and Aids prevalence rate in Zimbabwe, more still needed to be done in addressing the issue of stigma and all forms of discrimination against people living with the disease.
“Zimbabwe is one of the few countries in the world which was innovative enough in mobilising funds to help fight HIV and Aids. We recorded a sharp decline in the HIV and Aids infections over the last few years with our statistics indicating we are now at 13,7 percent in the adult HIV infection down from 21 percent five years ago.
“We however, continue to face the challenge of stigmatisation and discrimina-tion against people living the HIV virus resulting in less people willing to go for testing and counselling. Stigmatisation and discrimination does not only make it more difficult for people trying to come to terms with HIV and Aids and manage their illness on a personal level, but it also interferes with attempts to fight the Aids epidemic as a whole,” he said.
The word “stigma” is of Greek origin and was used to describe a mark or scar left typically when branding animals. There is no clear consensus on the definition, but in everyday parlance it now can be described as “a severe social disapproval” due to believed or actual individual characteristics, beliefs or behaviours that are against norms, be they economic, political, cultural or social.
HIV and Aids-related stigma and discrimination refer to prejudice, negative attitudes, abuse and maltreatment directed at people living with HIV and Aids. Stigmatisation against people living with the disease occurs alongside other forms of stigma and discrimination such as racism, stigma based on physical appearance, homophobia or misogyny and can be directed towards those involved in what are considered socially unacceptable activities such as prostitution or drug abuse.
The consequences of stigma and discrimination are wide-ranging and these include being shunned by family, peers and the wider community, poor treatment in healthcare and education settings, an erosion of rights, psychological damage, and a negative effect on the success of HIV testing and treatment.
HIV and Aids related stigma and discrimination exist worldwide, although they manifest themselves differently across countries, communities, religious groups and individuals. On a national level, the stigma associated with HIV and Aids can deter governments from taking fast, effective action against the epidemic, while on a personal level it can make individuals reluctant to access HIV testing, treatment and care.
In 2005, world leaders at the G8 summit in Gleneagles and at the UN World Summit in New York pledged to reach universal access to prevention, care and treatment by 2010. Though this target was not achieved, leaders recommitted to the fight against HIV and Aids in 2011 by agreeing to work toward achieving universal access to HIV prevention, treatment, care and support by 2015.
Delivering these essential services will not only require a strengthening of health systems, especially in Africa, which is home to two-thirds of those requiring antiretroviral (ARV) treatment, but also putting mechanisms in place aimed at fighting stigma and all forms of discrimination against people living with the disease. Health experts have cited HIV and Aids related stigma as a major contributory factor to the spread of the disease.
Nac director for monitoring and evaluation, Mr Amon Mpofu said under their five-year strategic plan, they aimed at preventing new infections and reducing mortality and morbidity through ensuring that people living with HIV and Aids had universal access to treatment.
He however, said in coordinating and managing the national response to the epidemic there was a need to address the issue of HIV and Aids related stigma.
“There is need for Government and policy makers to put in place policies that support HIV and Aids interventions. Health systems should be strengthened by continuously reviewing them to make sure they relate to the challenges on the ground.
“We need to address stigma and all forms of discrimination against people living with the disease,” he said.
The National Coordinator of Aids and TB Unit in the Ministry of Health and Child Welfare, Ms Gertrude Ncube noted that the factors that contributed to HIV and Aids- related stigma include a lot of inaccurate information about how HIV is transmitted, the creation of irrational behaviour and misperceptions of personal risk.
“HIV infection is associated with behaviours such as homosexuality, drug addiction, prostitution that are already stigmatised in many societies. HIV and Aids is a life-threatening disease, and therefore people react to it in strong ways such that most people become infected with HIV through sex, which often carries moral baggage,” she said.
HIV infection is often thought to be the result of personal irresponsibility and religious or moral beliefs lead some people to believe that being infected with HIV and Aids is the result of moral fault such as “deviant sex” that deserves to be punished.
The effects of antiretroviral therapy on people’s physical appearance can result in forced disclosure and discrimination based on appearance.
HIV and Aids-related stigma has had a profound effect on the epidemic’s course. The World Health Organisation (WHO) cites fear of stigma and discrimination as the main reason why people are reluctant to be tested, to disclose their HIV status or to take antiretroviral drugs.
One study found that participants who reported high levels of stigma were more than four times more likely to report poor access to care. These factors all contribute to the expansion of the epidemic as people would be reluctant to determine their HIV status or to discuss or practice safe sex.
An unwillingness to take an HIV test means that more people are diagnosed late, when the virus has already progressed to Aids, making treatment less effective and causing early death. Stigma also worsens problems faced by children orphaned by Aids. HIV and Aids orphans may encounter hostility from their extended families and community, and may be rejected, denied access to schooling and health care, and left to fend for themselves.
In the workplace, people living with HIV and Aids may suffer stigma from their co-workers and employers, such as social isolation and ridicule or experience discriminatory practices, such as termination or refusal of employment.
The fear of contagion coupled with negative, value-based assumptions about people who are infected leads to high levels of stigma surrounding HIV and Aids. Many countries have laws that restrict the entry, stay and residence of people living with HIV.
As of September 2011, people living with HIV were subject to some sort of restriction on their travel or stay in 47 countries, territories and area.
Until the 4 January 2010 the United States restricted all HIV positive people from entering the country, whether they were on holiday or visiting on a longer-term basis.
Some countries have policies that could violate confidentiality of status if, for example, a stamp is required on a waiver or passport in order to gain entry or stay. Students living with HIV and Aids are barred from applying to study in certain countries including Malaysia and Syria.
Deportation of people living with HIV has potentially life-threatening consequences if they have been taking HIV treatment. If they are deported to a country that has limited treatment provision, this could lead to drug resistance and death. Alternatively, people living with HIV and Aids may face deportation to a country where they would be subject to even further discrimination — a practice that could contravene international law.
In the majority of developing countries, families are the primary caregivers when somebody falls ill. There is clear evidence that families play an important role in providing support and care for people living with HIV and Aids.
However, not all family responses are supportive. HIV positive members of the family can find themselves stigmatised and discriminated against within the home. There is concern that women and non-heterosexual family members are more likely than children and men to be mistreated.
HIV and Aids-related stigma and discrimination severely hamper efforts to effectively fight the epidemic. Fear of discrimination often prevents people from seeking treatment for HIV and Aids or from admitting their HIV status publicly.
Nac behavioural change manager, Mr Oscar Mundido said high levels of stigma and discrimination were among the major drivers of the spread of HIV and Aids in Zimbabwe and globally.
“Community level stigma and discrimination towards people living with HIV and Aids is the greatest barrier to the fight against the disease and it is found all over the world. Research has shown that it is one of the major key drivers of HIV and Aids and it should be noted that a community’s reaction to somebody living with HIV and Aids can have a huge effect on that person’s life,” he said.
In an effort to address the issue of HIV and Aids related stigma and discrimination in Zimbabwe, the Government on 20 June this year launched the people living with HIV and Aids stigma index, a tool that is used to measure the levels of stigma.
Government is working in partnership with organisations such as Nac, UNAids and Anglican Church in addressing HIV and Aids related stigma and discrimination.
The media should also play a leading role in sensitising the populace and raising awareness on the need to shun all forms of discrimination against people living with HIV and Aids. The disease has a wide socio-economic impact that threatens development progress in many poor countries, especially those in sub-Saharan Africa.
The stigma attached to HIV and Aids can extend to the next generation, placing an emotional burden on those left behind. There is therefore a need to join hands in the fight against HIV and Aids related stigma and discrimination. People living with the disease should also be involved in the fight HIV and Aids related stigma and discrimination.
The community should also be taught the language and proper terminology that describes people living with HIV and Aids and the media should be at the forefront in highlighting that as the watchdog of society.
However, although there is no policy or laws that can alone combat HIV and Aids related stigma and discrimination, this scourge will sadly continue to exist for as long as societies as a whole have a poor understanding of HIV and Aids. The pain and suffering caused by negative attitudes and discriminatory practices, the fear and prejudice that lie at the core of the HIV and Aids-related discrimination need to be tackled at the community and national levels through HIV and Aids education, which indeed plays a crucial role.
A more enabling environment needs to be created to increase the visibility of people with HIV and Aids as a “normal” part of any society. The presence of treatment can make this task easier; where there is the opportunity to live a fulfilling and long life with HIV and Aids, people are less afraid of the disease; they are more willing to be tested for HIV, to disclose their status, and to seek care if necessary. In some countries including Zimbabwe people living with HIV and Aids lack knowledge of their rights in society.
In this case, education is needed so that they are able to challenge the discrimination, stigma and denial that they encounter.
Institutional and other monitoring mechanisms can enforce the rights of people with HIV and Aids and provide powerful means of mitigating the worst effects of discrimination and stigma. Combating stigma and discrimination against people who are affected by HIV and Aids is vital to preventing and controlling the global epidemic.
The major task is therefore to confront the fear-based messages and biased social attitudes, in order to reduce the discrimination and stigma of people living with HIV and Aids.
Online Reporter