All over the world, the epidemics of HIV and AIDS are having a profound impact, bringing out the best and the worst in people. They trigger the best when individuals group together in solidarity to combat government, community and individual denial, and to offer support and care to people living with HIV and AIDS. They bring out the worst when individuals are stigmatized and ostracized by their loved ones, their family and their communities, and discriminated against individually as well as institutionally. Stigma and discrimination are the major obstacles to effective HIV/AIDS prevention and care. Fear of discrimination may prevent people from seeking treatment for AIDS or from acknowledging their HIV status publicly. People with, or suspected of having, HIV may be turned away from health care services, denied housing and employment, shunned by their friends and colleagues, turned down for insurance coverage or refused entry into foreign countries. In some cases, they may be evicted from home by their families, divorced by their spouses, and suffer physical violence or even murder. The stigma attached to HIV/AIDS may extend into the next generation, placing an emotional burden on children who may also be trying to cope with the death of their parents from AIDS. With its focus on stigma and discrimination, the Campaign will encourage people to break the silence and the barriers to effective HIV/AIDS prevention and care. Only by confronting stigma and discrimination will the fight against HIV/AIDS be won.

The nature of stigma and discrimination: -

--The "undesirable differences" and "spoiled identities" that HIV/AIDS-related stigma causes do not naturally exist, they are created by individuals and by communities. Stigmatization describes this process of devaluation.

--HIV/AIDS-related stigma builds upon, and reinforces, existing prejudices. It also plays into, and strengthens, existing social inequalities -- especially those of gender, sexuality and race.

--HIV/AIDS-related stigma and discrimination play a key role in producing and reproducing relations of power and control. They cause some groups to be devalued and others to feel that they are superior. Ultimately, stigma creates and is reinforced by social inequality.

Stigma, discrimination and human rights: -

Stigma harms. It can lead to feelings of shame, depression, withdrawal, worthlessness and guilt. It silences individuals and communities, saps their strength and increases their vulnerability. It isolates people and deprives them of care and support, thereby worsening the impact of infection.

HIV/AIDS-related stigma devalues persons living with, or who are presumed to be living with, HIV/AIDS, as well as the individuals, groups and communities with which they are associated.

Stigma derives from the association of HIV/AIDS with sex, disease and death, and with behaviors that may be illegal, forbidden or taboo, such as pre- and extra-marital sex, sex work, sex between men and injecting drug use.

HIV/AIDS-related stigma also builds upon, and reinforces, existing prejudices. HIV-related discrimination refers to actions that result from stigma. Discrimination occurs when a distinction is made against a person because of his or her (actual or presumed) HIV status, or because the person is seen to belong to a particular group (for example, sex workers, men who have sex with men or injecting drug users). Such actions result in the person being treated unfairly and unjustly.

Freedom from discrimination is a fundamental human right that is confirmed in the core international human rights instruments.

Freedom from discrimination is essential for the realization of other rights. Thus, discrimination against people living with HIV/AIDS, or those presumed to be infected, is a clear violation of their human rights.
Stigma, discrimination and human rights violations combine to form a vicious circle: they create, legitimize and reinforce each other.

--Prejudiced and stigmatizing thoughts frequently lead a person to do (or not do) something that denies services or entitlements to another person. For example, they may prevent health services being used by a person living with HIV/AIDS, or terminate their employment on the grounds of their HIV status. This is discrimination.
--Discrimination occurs when a distinction is made against a person that results in their being treated unfairly and unjustly on the basis of their belonging, or being perceived to belong, to a particular group.
--Due to stigma and HIV/AIDS-related discrimination, the rights of people living with HIV/AIDS and their families are frequently violated simply because they are known, or presumed, to have HIV/AIDS. This violation of rights hinders the response and increases the negative impact of the epidemic.
--Freedom from discrimination is a fundamental human right founded on principles of natural justice that are universal and perpetual. The basic characteristics of human rights are that they inhere in individuals because they are human, and that they apply to people everywhere.
--The Principle of Non-discrimination is central to human rights thinking and practice. All international human rights instruments and the African Charter (1) prohibit discrimination based race, colour, sex, language, religion, political or other opinion, national, ethnic or social origin, property, disability, fortune, birth or other status.
--Discrimination against people living with HIV/AIDS, or those thought to be infected, is therefore a clear violation of their human rights.
--The forms of stigma and discrimination faced by people with HIV/AIDS are multiple and complex. Individuals tend to not only be stigmatized and discriminated against because of their HIV status, but also because of what this connotes. Recent UNAIDS-sponsored research in India and Uganda shows that women with HIV/AIDS may be doubly stigmatized - both as 'women' and as 'people living with HIV/AIDS' when their sieropositivity becomes known.(3)
--States have obligations to respect protect and fulfill human rights. In relation to stigma and discrimination, for example, the obligation to respect requires States not to directly or indirectly discriminate in law, policy or practice. The obligation to protect requires States to take measures that prevent third parties from discriminating, (4) and the obligation to fulfill requires States to adopt appropriate legislative, budgetary, judicial, promotional and other measures to ensure that strategies, policies and programmes are developed that address the discrimination, and ensure that compensation is paid to those who suffer discrimination.

Action to address stigma and discrimination: -

--The human rights framework provides access to existing procedural, institutional and other monitoring mechanisms for enforcing the rights of people living with HIV and AIDS, and for countering and redressing discriminatory action.
--Appropriate reporting and enforcement mechanisms (ranging from legal aid services to hotlines for reporting acts of discrimination and violence) have provided powerful and rapid means of mitigating the worst affects of HIV/AIDS-related stigmatization and discrimination.
--Experience has shown that two complementary kinds of alleviation strategies are necessary to address stigma and discrimination: (i) strategies that prevent stigma or prejudicial thoughts being formed and (ii) strategies that address or redress the situation when stigma persists and is acted upon through discriminatory action, leading to negative consequences or the denial of entitlements or services.
--Ultimately, it is at the community and national levels that HIV/AIDS-related stigma and discrimination are most effectively combated. Communities and community leaders must advocate for inclusiveness and equality irrespective of HIV status.
(1) The right to non-discrimination is enshrined in Article 2 of the Universal Declaration on Human Rights; International Covenant on Civil and Political Rights; International Covenant on Economic Social and Cultural Rights; Convention on Elimination of All Forms of Discrimination Against Women; Convention on the Rights on the Child; the African Charter.
(2) For example, adopting of legislation to ensure the equal access to health care and health related services provided by third parties; to control the marketing of medicines and medical equipment and to ensure that medical practitioners and other health professionals meet appropriate standards of education, skill and ethical codes of conduct.

Dealing with Stigma and Discrimination

Given the intimate link between HIV/AIDS-related stigma, discrimination and human rights violations, multi-pronged interventions are needed. Thus, action must be taken to prevent stigma and challenge discrimination when it occurs, and monitor and redress human rights violations.
The Declaration of Commitment (endorsed at the UN General Assembly Special Session on HIV/AIDS in June 2001) calls on States, by the year 2003, to enact, strengthen or enforce legislation, regulations and other measures to eliminate all forms of discrimination against people living with HIV/AIDS and members of vulnerable groups. It also calls on States to take steps that ensure those groups enjoy all human rights and fundamental freedoms, and to develop strategies to combat the stigma and social exclusion connected with the epidemic.
The 2002-2003 World AIDS Campaign will encourage leaders at all levels, and in all walks of life, to visibly challenge HIV-related discrimination, spearhead public action and act against the many other forms of discrimination that people face in relation to HIV/AIDS. Also key is the active involvement of people living with HIV/AIDS in the response to the epidemic, and in ensuring that prevention, treatment and support services are accessible to all.

Conclusion: -

The individuals suffering from HIV/AIDS should not be automatically considered as sinful or evil as they are worthy of sympathy like any person suffering from whatever the illness. It must be made clear that HIV/AIDS is not only a disease of homosexuals, prostitutes, drug addicts, sinners or persons punished by God but also affects the newborn, a feeding infant and innocent recipient of blood transfusion. The fear of being discriminated in selection for education and employment; respect within family or society; being punished rather than treated leads to denial of disease and seeking treatment or investigation. This flares and spreads the illness like an unchecked jungle fire with equally devastating results. If this fire has to be effectively extinguished, the fire fighting team must include every member of the society and not just the healthcare workers.
Recommendations include reduction of impact of stigma in general. Strengthening the legal framework to protect the human rights of people with HIV/AIDS is of paramount importance. Supportive environment should be to reduce stigma through national and community-based communication initiatives to combat fear and misinformation; to improve community based services for people living with HIV/AIDS; and to increase accessibility to affordable antiretroviral (ARV) therapy.
The team workers should remove all prejudices and discriminations against HIV/AIDS sufferers and must comprise of educationists, clergy, media personnel, lawyers, youth etc. They should carry a strong message "Fight AIDS not people with AIDS."