CONFRONTING STIGMA AND

DISCRIMINATION

Stigma and discrimination are social and structural processes of disempowerment. Ignorance, fear and hatred create groups that are considered less valuable and less human than others, and consequently less worthy of human dignity. These divisions are often reinforced through laws, policies, governmental practices and other structural barriers.

In the early days of the HIV epidemic, pervasive stigma and discrimination against people at high risk of HIV infection and people living with HIV greatly slowed AIDS responses. Decades of civil society advocacy and awareness-raising have seen many reclaim their rights.

Civil society networks and human rights organizations have successfully challenged punitive laws and blocked proposed punitive legislation. There is now global expert consensus that not only do such laws harm the HIV response and run counter to human rights, but they are also ineffective and counterproductive for meeting their

stated goals of reducing new infections (1). Grass-roots activism has also seen same-sex sexual relationships decriminalized and transgender people empowered in dozens of countries across all continents.

However, people at greatest need of HIV services remain criminalized and marginalized in many countries.

People continue to be denied health care, employment and housing, and they face discrimination from health-care workers, police, prosecutors and judges because of their HIV status and because they are suspected of being sex workers, people who inject drugs or lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

In addition, members of groups that experience stigma and discrimination often internalize these negative views. Supporting the full and meaningful involvement of people living with and affected by HIV underpins efforts to transform these unjust power hierarchies and protect their human rights.

AT A GLANCE

Gains have been made against HIV-related stigma and discrimination, but discriminatory attitudes towards people living with HIV remain extremely high in far too many countries.

Discrimination can manifest in criminal laws, aggressive law enforcement, harassment and violence that push key populations and people living with HIV to the margins of society and deny them access to services.

The percentage of the world’s population that lives in countries that criminalize same-sex sexual relationships has fallen dramatically in recent years. However, more than half of coun-tries in Africa still have anti-homosexuality laws.

Community-level accountability and oversight mechanisms, such as local health committees and paralegal health advocates, help realize people’s right to health and ensure that breaches of rights are remedied.

CONFRONTING STIGMA AND DISCRIMINATION

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Note: The data points for each country are for three surveys conducted within 2000–2018. Survey years vary by country.

Data for Belize, Cameroon, Eswatini, Kazakhstan, Mauritania, Mongolia, Nepal and Viet Nam are for female respondents only.

FIGURE 6.1 Percentage of people aged 15–49 years who would not buy vegetables from a shopkeeper living with HIV, countries with available data, 2000–2018

0

Mauritania Ethiopia Uganda

Mozambique

HIV-related stigma remains far too high In the early days of the HIV epidemic, pervasive stigma and discrimination against people at high risk of HIV infection and people living with HIV nearly paralysed the AIDS response. Efforts to dispel the stigma surrounding the epidemic have had a measurable positive effect in eastern and southern Africa, where population-based surveys show lower levels of stigmatizing attitudes and declines in nine of 10 countries with sufficient data to track long-term trends (Figure 6.1). Progress has been mixed in other regions.

Discriminatory attitudes towards people living with HIV remain extremely high in far too many countries. Across 26 countries with recent population-based survey data for a composite indicator developed by UNAIDS, more than half of respondents expressed discriminatory attitudes (Figure 6.2).¹ In 29 of 68 countries with available data on one of the two questions within the composite indicator between 2013 and 2018, over half of people aged 15–49 years said they would not buy fresh vegetables from a shopkeeper living with HIV; in three of these countries, more than three quarters said they would not do so (Figure 6.3).

1 This indicator is constructed from responses to the following questions in a general population survey from respondents who have heard of HIV: (1) Would you buy fresh vegetables from a shopkeeper or vendor if you knew that this person had HIV? (2) Do you think that children living with HIV should be able to attend school with children who are HIV-negative? An individual is considered to have discriminatory attitudes towards people living with HIV if he or she responds “no” to either of the two questions.

The Global Partnership for action to eliminate all forms of HIV related stigma and discrimination (Global Partnership) was launched on Human Rights Day, 10 December 2018. The Global Partnership aims to catalyze and accelerate implementation of commitments made to end HIV-related stigma and discrimination as essential for ending AIDS as part of achieving the Sustainable Development Goals by 2030. The partnership is co-convened by UN Women, UNDP, the UNAIDS Secretariat, the Global Network of People Living with HIV (GNP+) and the nongovernmental organizations delegation of the UNAIDS Programme Coordinating Board.

The partnership’s implementation strategy will initially focus on health-care settings, workplace settings, educational settings, the justice system, household settings (individuals, families and communities), emergencies and humanitarian settings. All countries and partners committed to the HIV response and human rights principles are encouraged to join the global partnership and use their collective strength to eliminate HIV-related stigma and discrimination.

117

Zimbabwe Malawi Lesot

ho Kenya Rwanda Eswat

ini

Source: Population-based surveys, 2000–2018.

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FIGURE 6.2 Percentage of people aged 15–49 years who report discriminatory attitudes towards people living with HIV, countries with available data, 2014–2018

0

Philippines Timor-Leste Lao People's Democratic Republic Nepal India Thailand Haiti Belize Ethiopia Angola Uganda Zimbabwe Malawi South Africa Tajikistan Albania Armenia Guinea Mauritania Sierra Leone Senegal Mali Côte d'Ivoire Nigeria Congo Burundi

Asia and the Pacific Caribbean

Per cent

Eastern and

southern Africa Eastern Europe

and central Asia Western and central Africa Note: Discriminatory attitudes are measured through "No" responses to either of two questions: (1) Would you buy fresh vegetables from a shopkeeper or vendor if you knew this person had HIV?; and (2) Do you think that children living with HIV should be able to attend school with children who are HIV-negative?

Sources: Population-based surveys, 2014–2018, countries with available data.

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Note: Data for Algeria, Bangladesh, Egypt, El Salvador, Guinea, Kazakhstan, Kyrgyzstan, Panama, Paraguay, the Philippines, the Sudan, Tajikistan, Turkmenistan, Uruguay, Yemen and Viet Nam are for female respondents only.

Source: Population-based surveys, 2013–2018.

0–24% 25–49% 50–74% 75–100% No data

FIGURE 6.3 Percentage of people aged 15–49 years who would not buy vegetables from a shopkeeper living with HIV, 2013–2018