The right to health is a fundamental human right that includes access to affordable, timely and quality healthcare services for all. Discrimination in healthcare settings is known to undermine investments in health systems, deter people from accessing or seeking health services, disempower and deprive people of their basic dignity 1. This is further exacerbated when it comes to discussing HIV/AIDS.
Despite the general declining trend in the number of new HIV/AIDS infections, 1.8 million people became newly infected with HIV in 2016 2; the majority of whom include men who have sex with men (MSM), transgender, people who inject drugs (PWID), and adolescent and young adult sex workers 3,4. These population groups continue to have the highest risk of contracting and transmitting HIV; men who have sex with men (MSM) are 19 times more likely to be HIV-positive than the general population and the HIV prevalence among PWID is 28 times higher than the rest of the adult population 3. This is largely contributed due to the widespread cultural, legal and religious beliefs leading to the criminalization of their behaviour, stigmatization, and marginalization of these key populations even in healthcare settings. This makes them least likely to access prevention, care, and treatment services, leaving majority under-diagnosed and under-treated.
Today as we celebrate Zero Discrimination in healthcare settings, HIV stigma and discrimination in healthcare settings remains a persistent and chronic problem, in responding to the epidemic. Healthcare settings which are supposed to be an oasis free from any discrimination are unfortunately one of the key institutions contributing to overall HIV stigma and discrimination 4. This comes in the form of healthcare providers minimizing contact with patients living with HIV due to fear of contracting the disease, delaying or denying treatment to key populations due to the association of HIV with immoral behaviour and judgement based on their sexual orientation or gender identity and violation of patient’s privacy and confidentiality such as disclosing a person’s HIV status to family members or hospital employees without authorization 5. Thus discouraging key populations from seeking the care they need and deserve. Furthermore, the relegation of stigma reduction efforts to the bottom of AIDS program priorities continues to hinder the efforts towards the reduction of the spread and transmission of HIV/AIDS and sustained access to ARVs 6. In spite of this, there is a silver living, experience and further research has shown that equipping healthcare providers with comprehensive knowledge on HIV, is significantly associated with less stigmatization and discrimination amongst healthcare providers; which provides a great opportunity for the global community in tackling this issue 7.
“Healthcare settings should be safe and supportive environments. It is unacceptable that discrimination is inhibiting access to care today,”
(Executive Director of UNAIDS, Michel Sidibé)
Stigma is definitely a complex issue involving inequities in social, political, and economic power. Steps in tackling this issue will require joint efforts from several stakeholders ranging from community leaders, healthcare workers, people living with HIV, key populations and policymakers. It is definitely a tall order to tackle but is certainly achievable. The global community can start by increasing efforts towards reducing stigma and discrimination within healthcare facilities; through increased training for healthcare workers and establishing and following through on clear protocols free from HIV-related stigma and discrimination.
Friendly environment for key populations within healthcare facilities, but also other people living with HIV. Eventually, this may create a spillover effect towards reducing stigma and discrimination in the communities of these healthcare providers. For many people, the health system provides their only connection to a state institution 1, directly shaping their experience of citizenship. Therefore stigma and discrimination only serve to reinforce their exclusion from society.
If the global community wants to achieve target 3.3 of SDG 3, to end the AIDS epidemic, dealing with stigma and discrimination needs to be one of the top priorities when discussing and implementing HIV interventions!
- World Health Organization (2017). Ending discrimination in healthcare settings. Available at: <http://www.who.int/mediacentre/commentaries/discrimination-health-care/en/>
- UNAIDS (2018). Fact sheet – Latest statistics on the status of the AIDS epidemic. Available at: <http://www.unaids.org/en/resources/fact-sheet>
- PSI (2016). Priority Populations. Available at: <http://www.psi.org/program/priority-populations/>
- UNAIDS (2016). ‘Feature story: HIV prevention among key populations’ <http://www.unaids.org/en/resources/presscentre/featurestories/2016/november/20161121_keypops>
- UNAIDS (2017). ‘Agenda for zero discrimination in health-care settings’[pdf] <http://www.unaids.org/sites/default/files/media_asset/2017ZeroDiscriminationHealthCare.pdf>
- Maharajan, A.P., Sayles, J.N., Patel, V.A., Remien, R.H., Ortiz, D., Sxekeres, G. & Coates, T. (2008). Stigma in the HIV/AIDS epidemic: A review of the literature and recommendations for the way forward. AIDS, 22(2), 67-79. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835402/> .
- Feyissa, G.T., Abebe, L., Girma, E. & Woldie, M. (2012). Stigma and discrimination against people living with HIV by healthcare providers, Southwest Ethiopia. BMC Public Health, 12(522). Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3506482/>
Dr. Meggie Mwoka serves as a Medical Officer of the Government of Kenya. She has experience in global health and is an advocate for sexual and reproductive health rights. Her passion for youth engagement has led her to volunteer and leadership opportunities at international and national youth-led organizations. She serves as an active member in several organizations where she often provides consultation, especially on youth and health issues. She is currently pursuing her Master of Global Health at the Barcelona Institute for Global Health. As an aspiring global health specialist, she hopes to close the inequality gap within her country and globally; through collaboration and provision of equal access, opportunities and rights across all social and economic spheres.