Discrimination against people with HIV/AIDS
Discrimination against people living with HIV/AIDS ('PLHIV') is the experience of prejudice against PLHIV which falls within the purview of the law. Discrimination is one manifestation of stigma. Stigmatizing, attitudes, and behaviors may fall under the rubric of discrimination depending on the legislation of a particular country.
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HIV/AIDS stigma exists around the world in a variety of forms, including ostracism, rejection, discrimination and avoidance of HIV infected people; compulsory HIV testing without prior consent or protection of confidentiality; violence against HIV infected individuals or people who are perceived to be infected with HIV; the quarantine of HIV infected individuals1 and, in some cases, the loss of property rights when a spouse dies.2 Stigma-related violence or the fear of violence prevents many people from seeking HIV testing, returning for their results, or securing treatment, possibly turning what could be a manageable chronic illness into a death sentence and perpetuating the spread of HIV.3
HIV/AIDS stigma has been further divided into the following three categories:
- Instrumental AIDS stigma—a reflection of the fear and apprehension that are likely to be associated with any deadly and transmissible illness.4
- Symbolic AIDS stigma—the use of HIV/AIDS to express attitudes toward the social groups or lifestyles perceived to be associated with the disease.4
- Courtesy AIDS stigma—stigmatization of people connected to the issue of HIV/AIDS or HIV- positive people.5
Often, HIV/AIDS stigma or discrimination is expressed in accordance with one or more other stigmas, particularly those associated with homosexuality, bisexuality, promiscuity, sex workers, and intravenous drug use.6
In many developed countries, there is an association between HIV/AIDS and homosexuality or bisexuality, and this association is correlated with higher levels of sexual prejudice such as anti-homosexual attitudes.7 There is also a perceived association between AIDS and men who have sex with men (MSM), including sex between uninfected men.4 An early name for AIDS, gay-related immune deficiency or GRID, shows this prejudice. During the early 1980s, HIV/AIDS was considered "a disorder that appears to affect primarily male homosexuals" and Dr. Lawrence D. Mass, a New York City physician, said that "gay people whose lifestyle consists of anonymous sexual encounters are going to have to do some serious rethinking", suggesting that lesbian, gay and bisexual people cannot have monogamous relationships and are therefore more likely to develop GRID than straight people. 8
Some forms of serious discrimination can include: being expelled from school, being denied housing, having to pay extra rent, and job loss. Persons who have, or are perceived to have, HIV/AIDS, experience discrimination in various aspects of life. In the United States, disability laws prohibit HIV/AIDS discrimination in housing, employment, education, and access to health and social services. The U.S. Department of Housing and Urban Development's Office of Fair Housing and Equal Opportunity enforces laws prohibiting housing discrimination based on actual or perceived9 HIV/AIDS status.10
Main article: Structural violence
Structural violence is an important factor in the treatment of people living with AIDS. Paul Farmer argues that social determinants affecting the lives of certain cultural groups alter their risk of infections and their ability to access treatment.11 For example, access to prophylaxis, access to antiretroviral therapy, and susceptibility to illness and malnutrition are all factors which change people's overall risk of illness due to HIV/AIDS. This causes large difference in the rate of illness due to HIV/AIDS in various social/cultural groups. Farmer also argues that social intervention may be key in altering the gap in treatment between these groups of people. Educating doctors on the interactions between social life and healthcare would help level out the injustices in healthcare.
Current research has found that discrimination against people living with HIV is a contributing factor for delayed initiation of HIV treatment.12 As many as 20-40% of Americans who are HIV+ do not begin a care regimen within the first 6 months after diagnosis.13 When individuals begin treatment late in the progression of HIV (when CD4+ T cell counts are below 500 cells/µL), they have 1.94 times the risk of mortality compared to those whose treatment is initiated when CD4+ T cells are still about 500 cells/µL.14 In a 2011 study published in AIDS Patient Care and STDs (sample size 215), most of the barriers to care described involve stigma and shame.15 The most common reasons of not seeking treatment are “I didn’t want to tell anyone I was HIV-positive”, “I didn’t want to think about being HIV-positive”, and “I was too embarrassed/ashamed to go”.15 The presence and perpetuation of HIV stigma prevents many who are able to obtain treatment from feeling comfortable about addressing their health status.15
- "The impact of AIDS on people and societies" (PDF). 2006 Report on the global AIDS epidemic. UNAIDS. 2006. Retrieved 2006-06-14.
- Huairou Commission http://www.huairou.org/sites/default/files/Women%20HIV%20LAND%20working%20draft%207-15-10%20-%20black%20and%20white%20version.pdf
- Ogden J, Nyblade L (2005). "Common at its core: HIV-related stigma across contexts" (PDF). International Center for Research on Women. Retrieved 2007-02-15.
- Herek GM, Capitanio JP (1999). "AIDS Stigma and sexual prejudice" (PDF). American Behavioral Scientist 42 (7): 1130–1147. doi:10.1177/0002764299042007006. Retrieved 2006-03-27.
- Snyder M, Omoto AM, Crain AL (1999). "Punished for their good deeds: stigmatization for AIDS volunteers". American Behavioral Scientist 42 (7): 1175–1192. doi:10.1177/0002764299042007009.
- Understanding HIV/AIDS Stigma and Discrimination http://www.socialworkers.org/practice/hiv_aids/AIDS_Day2012.pdf
- Herek GM, Capitanio JP, Widaman KF (2002). "HIV-related stigma and knowledge in the United States: prevalence and trends, 1991-1999" (PDF). Am J Public Health 92 (3): 371–7. doi:10.2105/AJPH.92.3.371. PMC 1447082. PMID 11867313. Retrieved 2008-03-10.
- Farmer, Paul; Bruce Nizeye, Sara Stulac, Salmaan Keshavjee (2006). "Structural Violence and Clinical Medicine".
- Pharris et al. (2011). "Community patterns of stigma towards persons living with HIV: A population based latent class analysis from rural Vietnam". BMC Public Health. 705 11.
- Mugavero, MJ (2008). "Improving engagement in HIV care: What can we do?". Top HIV Med 16 (5): 156–161. PMID 19106431.
- Panel on Antiretroviral Guidelines for Adults and Adolescents (October 14, 2011). "Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents". Department of Health and Human Services.
- Pollini, Robin A.; Estela Blanco, Carol Crump, Maria Zuniga (2011). "A community-based study of barriers to HIV care initiation". AIDS Patient Care and STDs. 601-09.