HIV and AIDS-related stigma can lead to discrimination, for example, when people living with HIV are prohibited from travelling, using healthcare facilities or seeking employment.
Self-stigma, or internalised stigma has an equally damaging effect on the mental wellbeing of people living with HIV. This fear of discrimination breaks down confidence to seek help and medical care.
Self-stigma and fear of a negative community reaction can hinder efforts to address the HIV epidemic by continuing the wall of silence and shame surrounding the virus.
“I am afraid of giving my disease to my family members-especially my youngest brother who is so small. It would be so pitiful if he got the disease. I am aware that I have the disease so I do not touch him. I talk with him only.
A country’s discriminatory laws, rules and policies regarding HIV can alienate and exclude people living with HIV, reinforcing the stigma surrounding HIV and AIDS.
In 2014, 64% of countries reporting to UNAIDS had some form of legislation in place to protect people living with HIV from discrimination.
However, criminalisation of key affected populations remains widespread with 60% of countries reporting laws, regulations or policies that present obstacles to providing effective HIV prevention, treatment, care and support.16 In 2015, 75 countries worldwide listed homosexuality as a crime.
Healthcare professionals can medically assist someone infected or affected by HIV, and also provide life-saving information on how to prevent it.
However, often healthcare is not confidential, contains judgement about a person’s HIV status, behaviour, sexual orientation or gender identity. These views are often fuelled by ignorance about HIV transmission routes among healthcare professionals.19 Studies by the WHO in India, Indonesia, the Philippines and Thailand found that 34% of respondents reported breaches of confidentiality by health workers.
This prevents many people from being honest to healthcare workers when they seek medical help and fear discrimination if they say they’re a sex worker, have same-sex relations, or inject drugs.
In the workplace, people living with HIV 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.22 Fear of an employer’s reaction can cause a person living with HIV anxiety:
“It is always in the back of your mind, if I get a job, should I tell my employer about my HIV status? There is a fear of how they will react to it. It may cost you your job, it may make you so uncomfortable it changes relationships. Yet you would want to be able to explain about why you are absent, and going to the doctors.”
A man living with HIV in China filed a lawsuit in 2012 after he was denied a job as a primary school teacher when the employer found out he was HIV-positive. In January 2013, he won the case and received compensation. There is pressure now to remove health tests as part of any employment procedures in China.
By reducing stigma in the workplace (via HIV and AIDS education, offering HIV testing, and contributing towards the cost of antiretrovirals) employees are less likely to take days off work, and be more productive in their jobs. This ensures people living with HIV are able to continue working.
Community and household level stigma
Community-level stigma and discrimination towards people living with HIV can force people to leave their home and change their daily activities.
A survey of Dutch people living with HIV found that stigma in family settings – in particular avoidance, exaggerated kindness and being told to conceal one’s status – actively contributed to psychological distress.26 A global study found that 35% of participants feared losing family and friends if they disclosde their HIV status.
Stigma and discrimination can also take particular forms within community groups such as key affected populations.
For example, studies have shown that within some lesbian, gay, bisexual and transgender (LGBT) communities there is segregation between HIV-positive and HIV-negative men, where men associate predominately with those of the same status.
Restrictions on entry, travel and stay
As of September 2015, 35 countries have laws that restrict the entry, stay and residence of people living with HIV. Lithuania became the most recent country to remove such restrictions.
Restrictions can include the mandatory disclosure of one’s HIV status or be subject to a mandatory HIV test, the need for discretionary approval to stay, and the deportation of individuals once their HIV-positive status is discovered.
Deportation of people living with HIV has potentially life-threatening consequences if they have been taking HIV treatment and are deported to a country that has limited treatment provision. Alternatively, people living with HIV may face deportation to a country where they would be subject to even further discrimination – a practice that could contravene international human rights law.