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.
Seven key programmes to reduce stigma and discrimination
- Programmes to reduce stigma and discrimination;
- HIV-related legal services;
- Monitoring and reforming laws, regulations and policies relating to HIV;
- Legal literacy (Know Your Rights);
- Sensitisation of law-makers and law enforcement lawmakers;
- Training for health care providers on human rights and medical ethics related to HIV; and
- Reducing stigma against women in the context of HIV.
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.
HIV-related stigma: refers to the negative beliefs, feelings and attitudes towards people living with HIV, groups associated with people living with HIV (e.g. the families of people living with HIV) and key populations, such as people who inject drugs, sex workers, men who have sex with men and transgender people.
HIV-related discrimination:90 refers to the unfair and unjust treatment (act or omission) of an individual based on his or her real or perceived HIV status. Discrimination in the context of HIV also includes the unfair treatment of key populations, such as sex workers, people who inject drugs, men who have sex with men and transgender people. HIV-related discrimination is usually based on stigmatising attitudes and beliefs about populations, behaviours, practices, sex, illness and death. Discrimination can be institutionalised through existing laws, policies and practices that negatively focus on people living with HIV and marginalised groups, including criminalised populations.
The agenda for zero discrimination in health care91 UNAIDS and WHO’s Global Health Workforce Alliance launched the Agenda for Zero Discrimination in Health Care on 1 March 2016. The campaign works towards a world where everyone, everywhere, is able to receive the health care they need with no discrimination. The action plan underpinning the campaign has seven priorities:
- Remove legal and policy barriers that promote discrimination in health care.
- Set the standards for discrimination-free health care;
- Build and share the evidence base and best practices to eliminate discrimination in health care settings;
- Empower clients and civil society to demand discrimination-free health care;
- Increase funding support for a discrimination-free health workforce;
- Secure the leadership of professional health-care associations in actions to shape a discrimination-free health workforce; and
- Strengthen mechanisms and frameworks for monitoring, evaluation and accountability for discrimination-free health care.
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.
Training for health care providers on human rights and medical ethics related to HIV: one of the seven key programmes to reduce stigma One of the seven key programmes recommended by UNAIDS to reduce stigma and discrimination focusses on health care workers and takes a two-pronged approach:
- Health care workers are trained to know their own rights to health and non-discrimination in the context of HIV; and
- Health care workers are provided with tools to ensure patients’ human rights to confidentiality, informed consent, treatment and non-discrimination are respected. These skills help to reduce stigmatising attitudes amongst health care workers.
What can parliamentarians do to combat stigma and discrimination in health settings?
Undertake advocacy research: Parliamentarians can initiate research to assess that all NSPs include stigma reduction programmes; they can support community-led research on stigma and discrimination experienced by people living with HIV and key populations and in particular, they can support the use of the People Living with HIV Stigma Index; they can commission specific research on stigma and discrimination in health settings; and they can initiate research to assess whether there are specific laws and policies that prevent key populations from accessing health care.
Enact and strengthen protective laws: Parliamentarians can enact and draft laws protecting people living with HIV and key populations from discrimination, including in healthcare settings. They can:
- Promote anti-discrimination laws that protect people living with HIV and key populations from discrimination;
- Promote laws that protect women and girls from discrimination and protect them from violence;
- Promote equal, non-discriminatory access to HIV prevention, treatment, care and support and sexual and reproductive health care;
- Promote laws that decriminalise HIV transmission, sex work, drug use and same sex sexual conduct;
- Promote health laws that: o Do not require spousal or parental consent to access information and services about HIV prevention, treatment, care and support;
o Do not require spousal or parental consent to access sexual and reproductive healt care and information;
o Respect the right to medical confidentiality and privacy for people living with HIV and key populations; and
- Promote CSE for adolescents and young men and women, including information about the risk of cervical cancer.
Ensure accountability for implementation of commitments: Parliamentarians can undertake legal audits to assess the extent to which laws and policies are consistent with their international and regional human rights commitments and are working to reduce stigma and discrimination. They can also call for accountability to and reporting on efforts to meet related international and regional human rights commitments. They can meet with the relevant parliamentary committees to share information and concerns about discriminatory laws and assess what changes are necessary to advance equality for key populations and protect them from violations of their human rights.
They can meet with international and regional experts to discuss what law reform is necessary and advocate for legal and policy reform to ensure compliance. They can monitor and hold government ministries accountable for reporting on their progress towards amending discriminatory laws and enacting protective ones, and they can encourage civil society to monitor whether protective laws are being implemented. Where they find deficits, they can advocate for legal and policy reform to ensure compliance.
Budget monitoring: Parliamentarians can ensure that stigma reduction measures in NSPs are properly costed and that adequate budgetary provision is made for their implementation. They can encourage various ministries (e.g. health, education, justice) to budget for relevant programmes, including to train health care personnel (from doctors to nurses, health care assistants and attendants), especially those on the front lines, about dealing with key populations and people living with HIV.
Next, we discuss: Prevention