As part of the main drivers of the BAM Group of Companies, this being the umbrella company within which Informative Newspaper operates, alongside sister brands Finite Magazine, Finite Lifestyle Club, Bam Promotions and Twin Talk, Informative Newspaper takes particular interest in social issues and causes created to advance the development of young girls and women and their participation in the global space.
To advance and cement the organization’s support for women and young girls, the Sexual and Reproductive Health and Rights is today, through this issue introduced. Its purpose is to advance knowledge and create further awareness on developments surrounding the said community sector and to help audiences stay updated on such, further guiding means of both action and reaction to these developments.
This week we discuss Stigma and discrimination in health care settings
Stigma and discrimination make people vulnerable to HIV and are critical barriers to HIV prevention, treatment, care and support and SRH care. UNAIDS recommends that all national AIDS responses include specific programmes to reduce stigma and discrimination: to ensure that they are effective, UNAIDS further recommends that seven key programmes are included in National Strategic Plans (NSP) and operational plans. The programmes should be appropriately costed, and indicators developed to monitor implementation and progress.
People living with HIV experience stigma and discrimination on the grounds of their HIV status, but they may also experience additional stigma and discrimination on the basis of their sexual orientation, gender identity, drug use and sex work. Members of these key populations in turn may also experience stigma and discrimination on the basis of their HIV or perceived HIV status. Although progress has been made in combatting stigma and discrimination, it is not enough and has been uneven in the health sector where inadequate attention has been paid to this issue.87 UNAIDS reports that on average, one in eight people living with HIV reports being denied health services on the basis of their HIV status.
Transgender people may be at particularly high risk of experiencing stigma and discrimination when they seek access to health care which affects their access to HIV treatment, care and support. Transgender people living with HIV face well-documented barriers to ART and have lower rates of adherence. Stigma and discrimination in health care remains a persistent and serious concern and creates barriers to health care workers delivering quality services to patients and to the uptake and use of HIV prevention, care, treatment and support by patients. Stigma and discrimination in health settings are driven by many factors, including negative attitudes about the sexuality of people living with HIV and key populations, lack of information about HIV transmission and health workers’ own fear of becoming infected. Health care workers are critical to ensuring that people living with HIV and key populations have access to HIV prevention, treatment, care and support, as well as sexual and reproductive health care so that they can make informed decisions about sex, contraception and family planning.
International and regional human rights obligations The major international and regional human rights treaties prohibit discrimination and require governments to take steps to eliminate all forms of discrimination against individuals, including on the grounds of health and HIV status. The Committee on Economic, Social and Cultural Rights states that access to health care should be based on the principle of non-discrimination, especially for the most vulnerable and marginalised groups. In addition to their right to equality and non-discrimination, the right to the highest attainable standard of health is guaranteed under the African Charter on Human and People’s Rights, ICESCR and the CEDAW. Key populations must be able to access the right to health care on a non-discriminatory basis. States also have an obligation to ensure accountability and remedies when rights have been violated.
The 2016 Political Declaration on Ending AIDS reaffirms that state commitments include ensuring that health services comply with human rights standards, and that all forms of violence, discrimination and coercive practices in health-care settings are eliminated and prohibited. With respect to HIV, this includes that everyone has equal access to HIV prevention, treatment, care and support free from stigma and discrimination. Member States committed to addressing discrimination in health care, education and the workplace.
Impact of stigma and discrimination There is a large body of research that shows that stigma and discrimination, or fear of being discriminated against or stigmatised, undermines universal access to HIV prevention, treatment, care and support. Internalised stigma is particularly pernicious, preventing people living with HIV and key populations from accessing available treatment and support and those at risk of HIV from taking steps to prevent transmission and remain HIV negative.
A key reason for HIV-related stigma and discrimination relates to the fact that it is an STI and may also involve drug use and other behaviours that are criminalised. Not all health care workers are comfortable dealing with sex and sexuality and many are not appropriately trained to provide counselling, information and treatment to people living with HIV and key populations. In addition, health care workers are members of the communities they serve, and they often reflect the same stigma, especially towards key populations. Stigma in hospitals, clinics and other health facilities shows up in different ways: key populations and people living with HIV or perceived to be living with HIV are denied care or receive delayed, suboptimal care; patients experience breaches of their privacy, including disclosure of their HIV status without their consent; and they receive incomplete, inadequate or inaccurate information and cannot make informed decisions about their health. Health care workers may gossip about patients living with HIV, neglect their care and use gloves unnecessarily during interactions with patients. HIV-related discrimination includes HIV testing without informed consent, forced or coerced sterilisation of women living with HIV and isolation of patients.
Next we discuss what parliamentarians can do to combat stigma and discrimination in health settings.
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