Since the beginning of the HIV / AIDS epidemic, stigma and discrimination have created a breeding ground for HIV transmission and have greatly increased the negative impact of the epidemic. HIV stigma and discrimination continue to manifest itself in all countries and regions of the world, creating serious obstacles to preventing the spread of infection, providing adequate care, support and treatment, and mitigating the impact of the epidemic. Stigma associated with HIV/AIDS prevents an open discussion of the causes of the epidemic and the implementation of appropriate countermeasures. Open recognition of HIV / AIDS is a prerequisite for successful mobilization of the state, communities and individuals to counteract the epidemic. The silence of this problem can lead to the denial of its existence and hinders the adoption of urgent measures to solve it. Because of this, people living with HIV / AIDS are treated only as a source of problems, although they can participate in the containment of the epidemic and the establishment of control over it.
Stigma related to HIV / AIDS is based on numerous factors, including misunderstanding of the disease, misconceptions about the ways of HIV transmission, lack of access to treatment, irresponsible media reports on the epidemic, the incurable nature of AIDS, prejudices and fears for a number of delicate social issues such as sexual relations, disease and death, illegal drug use. Stigma can lead to discrimination and other human rights violations, which has a very negative impact on the well-being of people living with HIV / AIDS. In all countries of the world, there are many cases where people living with HIV / AIDS were denied access to medical services, were not employed and deprived of their rights to education and freedom of movement. To identify potential solutions to HIV-related stigma and discrimination, it is necessary to understand what these concepts mean, describe their manifestations and analyze the relationship between them. What is stigma? Stigma is described as a dynamic process of devaluation of the individual, which «largely discredits» the individual in the eyes of others.
The qualities on which stigma originates can be the most random — for example, skin color, manner of speaking or sexual orientation. In different cultures or societies certain qualities are considered to be defamatory or unworthy. HIV-related stigma is multifaceted and tends to develop and intensify negative factors due to the fact that HIV and AIDS are associated with behaviors that are already considered marginal, such as sex work, illicit drug use, homosexuality or transsexuality. In addition, it enhances the fears of «outsiders» and representatives of vulnerable groups, such as prisoners and migrants. It is widely believed that people living with HIV deserve their fate, because they committed some «wrong misconduct». Accusing certain people or certain groups of the population («not like everyone else»), other members of society do not recognize their own risk, relieve themselves of responsibility for solving the problem and providing care to the victims.
The image of people living with HIV in the press and on television can intensify the accusatory moods, if such definitions of HIV / AIDS as «women's illness», «addict's illness», «African disease» or «gang of homosexuals» are used. Religious ideas of sin can also help preserve and reinforce the notion that HIV infection is a punishment for misconduct. Stigma also manifests itself in language facilities. Since the beginning of the epidemic, strong metaphors, due to which HIV is associated with death, guilt and punishment, crimes, horror and «otherness» have created stigma and legitimized it.
The use of such language is associated with yet another aspect underlying the accusations and rejection, and further strengthens this aspect: it is the fear of people facing a deadly disease. To a certain extent, stigma based on fear is caused by people's fear of the consequences of HIV infection, in particular high mortality (especially if treatment is not provided widely), or fear of contracting, or fear of those who saw the state of AIDS patients at the last stage of the disease. Stigma can also occur on a different level.
People living with HIV can internally reconcile themselves with the negative attitude and reaction of others, and often this process leads to what is called «internal stigma» or self-stigmatization. Self-grammatization is related to what some authors describe as «perceived» stigma as opposed to «external stigma», since it primarily affects the self-esteem and self-esteem of an individual or community. In people living with HIV, this can be manifested in a sense of shame, inferiority, makes them blame themselves for what happened to them, and all this, together with a sense of social isolation, can lead to depression, closure and even occurrence of suicidal thoughts.
What is discrimination? Where stigma acts, discrimination occurs. Discrimination is action or inaction, and is directed against those people who are stigmatized. As defined by UNAIDS (2000), in the «Protocol for the detection of cases of discrimination against people living with HIV», discrimination is any form of arbitrary distinction, exclusion or restriction of rights, which adversely affects people, as a rule (but not only) in connection with their inherent personal characteristics or alleged membership of a particular group — in the case of HIV / AIDS, this applies to people with confirmed or suspected HIV-positive status, regardless of o, whether such measures are justified.
Discrimination in relation to AIDS can occur at different levels. There is discrimination in the family and community, and some authors call this form «established stigma». These are deliberate acts or omissions committed in order to humiliate other people, to deny them the provision of services or the exercise of their rights. Examples of this type of discrimination against people living with HIV can be very different:
– ostracism, that is, the expulsion of a woman from her husband's family to her relatives if she has received a positive diagnosis of HIV testing, or if there are early signs of the disease, or afterwards, how her partner died of AIDS;
– public isolation and refusal of everyday communication,
– verbal attacks, physical violence;
- HIV voluntary counseling and testing: gateway to prevention. UNAIDS, 2002. www.unaids.org