This fear of discrimination breaks down confidence to seek help and medical care.22 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.Negative self-judgement resulting in shame, worthlessness and blame represents an important but neglected aspect of living with HIV.These people are increasingly marginalised, not only from society, but from the services they need to protect themselves from HIV.Tags: Problem Solving Practice WorksheetsWhy Do We Get HomeworkEssay Writers In BangaloreScrum Research PaperNew Year Festival EssayDoes Research Papers Have Pictures
Although late diagnosis of HIV has declined in the UK in the last decade, from 56% in 2005 to 39% in 2015, this figure remains unacceptably high.18 In South Africa, stigma stopped many young women involved in a trial on HIV prevention from using vaginal gels and pills that would help them stay HIV free.
Many reported being afraid that using these products would lead them to being mistakenly identified as having HIV, and so the fear of the isolation and discrimination that being identified as living with HIV would bring led them to adapt behaviours that put them more at risk of acquiring the virus.19 The epidemic of fear, stigmatization and discrimination has undermined the ability of individuals, families and societies to protect themselves and provide support and reassurance to those affected.
Health providers may minimise contact with, or care of, patients living with HIV, delay or deny treatment, demand additional payment for services and isolate people living with HIV from other patients.43 For women living with HIV, denial of sexual and reproductive health and rights services can be devastating.
For example, 37.7% of women living with HIV surveyed in 2012 in a six-country study in the Asia–Pacific region reported being subjected to involuntary sterilisation.44 Healthcare workers may violate a patient’s privacy and confidentiality, including disclosure of a person’s HIV status to family members or hospital employees without authorisation.45 Studies by WHO in India, Indonesia, the Philippines and Thailand found that 34% of respondents reported breaches of confidentiality by health workers.46 People from key affected populations may face additional discrimination in healthcare settings.
Self-stigma affected a person's ability to live positively, limits meaningful self agency, quality of life, adherence to treatment and access to health services.23 In Zimbabwe, Trócaire and ZNNP designed, implemented and evaluated a 12-week pilot programme to support people living with HIV to work through self-stigmatising beliefs.
After the 12 weeks, participants reported profound shifts in their lives.
I am afraid of giving my disease to my family members-especially my youngest brother who is so small. I am aware that I have the disease so I do not touch him. In 2014, 64% of countries reporting to UNAIDS had some form of legislation in place to protect people living with HIV from discrimination.28 While, conversely, 72 countries have HIV-specific laws that prosecute people living with HIV for a range of offences.29 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.30 As of 2016, 73 countries criminalised same sex activity,31 and injecting drugs use is widely criminalised, leading to high incarceration levels among people who use drugs.32 More than 100 countries criminalise sex work or aspects of sex work.33 Even in countries where sex work is at least partially legal the law rarely protects sex workers and many are at risk of discrimination, abuse and violence from both state and non-state actors such as law enforcement, partners, family members and their clients.34 For example, some 15,000 sex workers in China were detained in so-called custody and education centres in 2013.35 Case study: Ending criminalisation of HIV transmission in Australia Laws that criminalise HIV non-disclosure, exposure and transmission perpetuate stigma and deter people from HIV testing and puts the responsibility of HIV prevention solely on the partner living with HIV.36In May 2015, the Australian state of Victoria repealed the country’s only HIV-specific law criminalising the intentional transmission of HIV.
The repealed law - Section 19A of the Crimes Act 1958 - carried a maximum penalty of 25 years imprisonment, even more than the maximum for manslaughter (which is 20 years).37The legislation to repeal the law was developed through the collaboration of several stakeholders, including legal, public health and human rights experts and representatives of people living with HIV.
Discrimination and other human rights violations may occur in health care settings, barring people from accessing health services or enjoying quality health care.3 Some people living with HIV and other key affected populations are shunned by family, peers and the wider community, while others face poor treatment in educational and work settings, erosion of their rights, and psychological damage.
These all limit access to HIV testing, treatment and other HIV services.4 5 The People Living with HIV Stigma Index documents the experiences of people living with HIV.