Stigma and discrimination

Humanity is behind in eradicating AIDS by 2030. This delay is not due to a lack of knowledge, capacity or means, but to structural inequalities such as stigma and discrimination which are obstacles to access health services.

Viruses such as HIV or COVID-19 do not differentiate between people, but societies do. They stigmatize and discriminate against people living with HIV, mostly out of ignorance, because they are afraid of the disease.

Discrimination remains one of the biggest battlefields in the Central African Republic and this is why the country was the first in the world to join the Global Partnership to fight against all forms of HIV-related discrimination and stigma.

To make this Global Partnership a reality, a Zero Discrimination Platform was established. It is composed of about thirty partners representing ministries, the National AIDS Council, UN agencies, technical and financial partners, civil society, human rights organizations and other organizations. With UNAIDS support, the Platform called on Ozaguin, the "king of Central African rumba" to use music and art to convey its messages of tolerance and compassion.

At the launch ceremony for Ozaguin's new song against discrimination, which took place on 9 December 2021 at the 20,000-seat stadium in Bangui, he was also nominated as a spokesperson for the Platform.

On behalf of the First Lady of the Central African Republic, the Minister of Health and Population invited every one, and in particular all institutions and influential personalities, not only not to discriminate, but also to fight against discrimination and stigmatization. "We must collectively report discrimination and stigma as soon as we see it and set an example. Discrimination kills. It exacerbates emergencies and fuels pandemics," said Minister Pierre Somsé.

The leadership shown by communities that are victims of discrimination and stigmatization remains a source of inspiration. Their determination, courage and vision are a star in the firmament, as demonstrated by the moving testimony of Ms. Christine Wilikon, a member of the national network of people living with HIV (RECAPEV) during the ceremony. "The first reactions to knowing my positive HIV status were dismay, and a desire to end my life. Rejection by my family members amplified my mental and social disorientation. But the support and advice provided by my parish priest gradually led to my social reintegration through income-generating activities such as petty trade, agriculture and market gardening.”, Christine shared. Her brave words were received with a standing ovation. She urged all Central Africans to put an end to feelings of guilt and shame, and to get tested to know their HIV status and if necessary, take the treatment which is free. 

Members of parliament have reaffirmed their commitment to tackle all forms of HIV-related stigma and discrimination in Jamaica and to help enhance efforts to create an enabling environment for people living with and affected by HIV.

At a meeting co-hosted by UNAIDS and Juliet Cuthbert-Flynn, the Minister of State for Health and Wellness and Chair of the country’s Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, members of parliament, from both the ruling and opposition parties, came together to review evidence on stigma and discrimination in Jamaica and its impact on health outcomes and to craft a way forward in which their role as lawmakers can contribute to eliminating stigma, discrimination and violence.

Jamaica’s legal landscape poses substantial barriers for people living with and affected by HIV to access health services. For example, same-sex sexual relations are criminalized in Jamaica, which continues to represent a considerable deterrent for marginalized communities. Moreover, the country lacks general legislation against discrimination, a national human rights institute and a gender recognition law that could provide further protection for transgender and gender non-conforming people in Jamaica.

Harmful laws, policies and generalized stigma and discrimination against people living with and affected by HIV have a profound negative effect on people’s health outcomes and life prospects. The most recent Knowledge, Attitudes, Practices and Behaviour Survey and the People Living with HIV Stigma Index showed that only approximately 12% of the general population have accepting attitudes towards people living with HIV, while close to 60% of people living with HIV have feelings of self-stigma. A 2019 study about the economic survivability of transgender and gender non-conforming communities in Jamaica found  that experiences of workplace stigma and discrimination were widespread, with about 60% of survey respondents declaring such incidents. Furthermore, 71% of respondents felt that transgender and gender non-conforming people had a harder time getting jobs than cisgender people. Another study suggests that approximately 20% of lesbian, gay, bisexual and transgender people in Jamaica have been homeless at some point of their lives.

In view of these pending challenges in the country’s HIV and human rights response, members of parliament explored creating a working group tasked with performing periodic reviews of relevant data, supporting the enactment of protective legislation, challenging harmful laws and policies and hosting permanent dialogues with communities of people living with and affected by HIV.

“We have a lot of work to do to ensure that all Jamaicans enjoy the full respect, protection and promotion of their rights. This meeting and its outcomes are a small step to achieving that goal, but a step that certainly is pointing us to the right direction on the role that members of parliament should play to end discrimination,” said Ms Cuthbert-Flynn.

These efforts, which aim to tackle deeply rooted misconceptions in society, require strong partnerships. As stated by Morais Guy, the Opposition Spokesperson on Health, who co-chaired the meeting, “The enhancement of people’s rights and collective efforts to ensure that every Jamaican can live a life free from stigma, discrimination and violence is not an issue of only one person, one entity or one political party. It is the business of all of us, to work in partnership for the dignity of all Jamaicans.” 

Members of parliament also discussed some of the challenges that they face as legislators to perform their duties, and the contributions that UNAIDS can make in facilitating a more efficient, effective and transparent law-making process in parliament. Moreover, options to mobilize and engage citizens at the community level to challenge stigma were also discussed in response to the critical need of raising more awareness, tolerance and respect towards people living with and affected by HIV.

“We are proud to partner with members of parliament to tackle stigma and discrimination in Jamaica and to provide all of the evidence, instruments and support that we can mobilize to leverage their role as allies and critical influencers in the future of the country,” said Manoela Manova, the UNAIDS Country Director for Jamaica. 

The goal of zero discrimination still eludes the Central African Republic. HIV-related stigma is pervasive in the lives of people living with HIV in the country. According to the 2018 People Living with HIV Stigma Index, discrimination affects almost all of the people living with HIV surveyed (more than 87%). And more than 45% of people living with HIV have experienced some form of stigma because of their HIV status. Stigma affects women (49%) more than men (37%).

“But the fight against HIV remains a public health priority for the government, which was the first country to join the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, in December 2019,” said Marguerite Ramadan, the Minister of Gender Promotion, Women’s Protection, Family and Children, Central African Republic.

Since its engagement in the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, the Central African Republic has implemented several key activities.

A memorandum of understanding was signed between the Ministry of National Defence and Reconstruction, the Ministry of Health and Population, the AIDS Control Council (CNLS) and UNAIDS to implement programmes aimed at eliminating gender-based violence and accelerating HIV prevention, treatment and care within the defence and security forces. A national charter of patients’ rights has been launched and is being disseminated progressively in health centres. A series of key human rights activities have been included in the Global Fund to Fight AIDS, Tuberculosis and Malaria’s grant for 2021–2023.

A Zero Discrimination Platform, composed of some 30 partners representing ministries, CNLS, United Nations agencies, technical and financial partners, civil society, human rights organizations and other organizations was launched in 2020 and is supporting these efforts, including through identifying synergies.

During the COVID-19 pandemic, initiatives have slowed down, so in order to relaunch the momentum of the Zero Discrimination Platform and agree on collective priorities for the end of 2021 and 2022, a validation workshop and launch of a joint workplan took place in Bangui, Central African Republic, on 28 October under the chairmanship of the Minister of Gender Promotion, Women’s Protection, Family and Children.

Priorities include the adoption of a revised law on HIV, the revision of training programmes for health professionals to include ethics and human rights, the signing of a memorandum of understanding between organizations of lawyers and networks of people living with HIV and key populations to provide free legal services and training on knowing your rights, the development of radio and television spots on discrimination issues and high-level advocacy for better integration of HIV issues in humanitarian interventions.

“The denial of health services to people living with HIV remains unfortunately common in the country, and the prevalence and effects of discrimination are often particularly severe for members of key populations, who face multiple and overlapping forms of discrimination,” said Marie Engel, Director, a.i., of the UNAIDS Country Office for the Central African Republic.

The Latin America and Caribbean region has deep and widespread inequalities and includes countries that are more unequal than those in other regions with similar levels of development. This affects access to health and HIV services, particularly by key populations. Social and structural barriers are important drivers of inequalities.

To understand these social and structural barriers better, Alianza Liderazgo Positivo y Poblaciones Clave (ALEP) is leading the multicountry People Living with HIV Stigma Index 2.0 study in four countries in the region: the Plurinational State of Bolivia, Ecuador, Peru and Nicaragua. Another five similar studies funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and in coordination with civil society, the United States President’s Emergency Plan for AIDS Relief, Global Fund principal recipients, the United Nations Population Fund and UNAIDS are independently under way in El Salvador, Honduras, Guatemala, Panama and Paraguay. 

The results of the joint initiative are expected to strengthen regional and global efforts to eliminate HIV-related stigma and discrimination through community-centred policies and programmes that are informed by evidence.

“For the first time since the first People Living with HIV Stigma Index study in 2008, nine countries in the same region will be conducting the study in coordination and within the same time frame. This is unprecedented and will be instrumental in addressing HIV-related stigma and discrimination both at the country and regional level,” said Rodrigo Pascal, ALEP’s People Living with HIV Stigma Index 2.0 Study Coordinator.

The People Living with HIV Stigma Index 2.0 gathers evidence on how stigma and discrimination impacts the lives of people living with HIV, including key populations. It was developed to be used by and for people living with HIV, including key populations, and was created to support the principle of the greater involvement of people living with HIV, under which networks are empowered to lead the implementation of the study. The study is a first, as it is the first time that networks of people living with HIV have coordinated action with networks of key populations to promote human rights and access to comprehensive and differentiated HIV care in Latin America.

“The motivation I have is to be part of the solution regarding the challenges imposed by stigma and discrimination, which are the main problems we, people living with HIV, are confronting since the beginning of the epidemic,” said HIV activist Gracia Violeta Ross Quiroga, who is coordinating the implementation of the stigma index study in the Plurinational State of Bolivia. “I have hope in this research because it is coming from the community, and such responses have proved to be the most effective in the history of HIV.”

ALEP is an innovative effort that combines the leadership, vision, capacities and strengths of regional networks in the Plurinational State of Bolivia, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Nicaragua, Panama, Paraguay and Peru. It works in partnership with Country Coordinating Mechanisms where there is a Global Fund programme in place, UNAIDS and the Pan American Health Organization.

“This is a solid example of how peers are contributing to their own communities while tackling key intersecting issues, such as human rights, stigma and discrimination, and other structural barriers. It’s essentially by communities, for communities,” said Guillermo Marquez, the Senior Community Support Adviser for the UNAIDS Regional Support Team for Latin America and the Caribbean. 

Watch launch event (in Spanish)

The Gallery Marie de Holmsky, in the heart of Paris, recently hosted the ArtPositive exhibition, an artistic project by visual artists living with HIV. The initiative aimed to use art as a tool to tackle the stigma, discrimination and isolation that people living with HIV still face.

ArtPositive featured works by visual artists Boré Ivanoff, Adrienne Seed and Nacho Hernandez Alvarez and by photographer Philipp Spiegel.

“We want to remind the world that AIDS is not a thing of the past. We want to remind everyone that all people living with HIV, even though thanks to advances in science they are not as threatened by death as they used to be years ago, today still face extremely cruel and unfair stigma, isolation and even discrimination,” said Mr Ivanoff. “I am convinced that art is the best way to overcome any stigma, isolation and discrimination based on differences and health status.”

About two years ago, after Mr Ivanoff, a Bulgarian-born Parisian artist, decided to make his HIV status public he received many messages of solidarity and support, but some close friends distanced themselves from him. “But this fact convinced me even more that I must continue to fight to open people’s eyes and to overcome this hypocritical way of thinking and treating people who have dared to reveal their HIV status,” he said. He emphasized that along with the creation of art, advocacy and activism are the only things that keep him in some psychological stability and give some existential impulse and a sense of doing something really important and useful for the good of humanity.

Adrienne Seed, an artist, writer, sculptor and HIV activist from Manchester, United Kingdom, who has been living with HIV for almost 10 years, recalled, “Back then, there were very few women speaking openly about living with HIV. I began to speak out via my website, via the media and, of course, via my art.”

“People living with HIV also live with stigma. We are judged by society and we are seemed to deserve some kind of punishment,” said José Manuel González Peeters, an artist living with HIV from Barcelona, Spain.

Philipp Spiegel, a photographer living with HIV from Vienna, Austria, explained that his work is part of a long-term project entitled The Privilege of Intimacy. “My HIV diagnosis stripped me of my feeling of intimacy for a long time; something that was once so natural to me had been taken away, after which I had to embark on a journey to rediscover what intimacy means to me, and to learn to appreciate it even more,” he said. “Reflecting upon this, I realized the absence of intimacy is more widespread than I had thought. Not only people living with HIV, but all people who live in fear of being ostracized or stigmatized for a wide range of reasons. Single mothers, LGBTQ+ people in certain environments or anyone who feels they need to hide out of societal reasons.”

“We, the artists living with HIV would like to express our sincere gratitude to all our official partners and all media around the world who have helped us popularize our cause, the fight against HIV stigma and the awareness that AIDS is not over yet,” said Mr Ivanoff, speaking on behalf of all the participants of ArtPositive.

“Stigma and discrimination results in people being treated differently, excluded from essential services or being subject to undue restrictions on how they live their lives, simply because of who they are. It is great to see how a community of artists living with HIV uses art as a medium to raise awareness and to challenge the drivers of stigma and discrimination among the wider public,” said Laurel Sprague, UNAIDS Special Adviser for Community Mobilization.

GENEVA, 11 August 2021—UNAIDS welcomes the announcement by Chile that it recognizes international responsibility for violating the rights of a woman living with HIV who was sterilized without her consent almost 20 years ago. The government has agreed a friendly settlement with the woman, Francisca, that includes the payment of reparations for the violation of her human rights. It has also committed to ending forced sterilization and to guaranteeing reproductive rights as human rights without discrimination.

Francisca delivered a healthy baby boy in 2002 and was then sterilized without her consent by the doctor who carried out her Caesarean section, making the decision that a woman living with HIV should not be able to have children. The friendly agreement announced this week comes after more than a decade’s litigation by the woman and her legal teams.

“This settlement is a significant moment for women around the world who have been fighting for reproductive justice for decades. Coercive sterilization of women living with HIV is a violation of women’s most fundamental human rights,” said UNAIDS Executive Director, Winnie Byanyima. “Unfortunately, this practice is still happening in many countries and efforts to stop it and bring justice to more women must be stepped up.”

This settlement comes after years of efforts before the Inter-American Commission on Human Rights (IACHR) after an earlier complaint in the Chilean justice system was unsuccessful. The case was litigated by the Chilean organization, Vivo Positivo, and the international human rights organization, Center for Reproductive Rights.

UNAIDS submitted an amicus brief to inform the IAHCR the standards that governments must uphold to address the HIV stigma and discrimination that impact women living with HIV. These include the obligation to respect, protect and fulfil women’s autonomy in decision making on matters related to their sexual and reproductive lives, their right to physical integrity and their right to be free from violence, including from violence by health personnel.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

UNAIDS fully backs calls made today by an eminent group of United Nations experts that Ghana should reject a proposed “family values bill” that targets the country’s lesbian, gay, bisexual, transgender and intersex community.

After analyzing the draft legislation, the independent experts appointed by the United Nations Human Rights Council concluded that adopting the legislation in its current or any partial form would be tantamount to a violation of a number of human rights standards, including the absolute prohibition of torture.

The experts said that the proposed law seeks to establish a system of State-sponsored discrimination and violence against the LGBTI community.

UNAIDS has already called for the law to be rejected as a gross violation of human rights. It has also warned that the legislation would be a grave setback for the HIV response in driving vulnerable people further away from essential HIV treatment, care and prevention services.

Ghana: Anti-LGBTI draft bill a “recipe for violence” – UN experts 

GENEVA, 12 August 2021 — UN human rights experts* urged Ghana’s Government to reject a proposed ‘family values’ bill, saying it seeks to establish a system of State-sponsored discrimination and violence against the LGBTI community. The first reading of the bill took place on 2 August 2021, and its consideration is expected to resume in October 2021.  

“The draft legislation argues that any person who deviates from an arbitrary standard of sexual orientation or gender identity is immediately to be considered dangerous, sick or anti-social,” said the experts. “Such laws are a textbook example of discrimination. 

“The proposed law promotes deeply harmful practices that amount to ill-treatment and are conducive to torture, such as so-called ‘conversion therapy’ and other heinous violations like unecessary medical procedures on intersex children, and so-called corrective rape for women,” they added. 

The independent experts, appointed by the Human Rights Council, presented an analysis of the draft bill to the Ghanaian Government, concluding that adopting the legislation in its current or any partial form would be tantamount to a violation of a number of human rights standards, including the absolute prohibition of torture.

For example, attempts to prevent human rights defenders from organising themselves to defend LGBTI people, and the absolute prohibition of public debate on sexual orientation and gender identity, raises grave concerns about rights to freedom of opinion and expression, and of association. Moreover, the bill in question would essentially legitimize the above instances of violence against LBTI women and reinforce existing gender stereotypes and discrimination against women, which are both cause and consequence of violence against women and girls.

“The consideration of this legislation is deeply perplexing in a country that has been regarded as a champion of democracy in Africa, with an impressive record of achieving certain Millennium Development Goals by 2015,” they said. They cited specific concerns about the MDG goals on health, education, employment, housing and gender justice. 

“The draft legislation appears to be the result of a deep loathing toward the LGBTI community. It will not only criminalise LGBTI people, but anyone who supports their human rights, shows sympathy to them or is even remotely associated with them.

“Given that LGBTI people are present in every family and every community it is not very difficult to imagine how, if it were to be adopted, this legislation could create a recipe for conflict and violence.” 

ENDS

*The experts: Victor Madrigal-Borloz, Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity; Reem Alsalem, Special Rapporteur on violence against women, its causes and consequences; Koumbou Boly Barry, Special Rapporteur on the right to education; Irene Khan; Special Rapporteur on the promotion and protection of the right to freedom of expression; Mary Lawlor, Special Rapporteur on the situation of human rights defenders; Nils Melzer, Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment; Tlaleng Mofokeng, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health; Elina Steinerte (Chair-Rapporteur), Miriam Estrada-Castillo (Vice-chairperson), Leigh Toomey, Mumba Malila, Priya Gopalan, Working Group on arbitrary detention Clément Nyaletsossi Voule, Special Rapporteur on Rights to Freedom of Peaceful Assembly and Association

The Special Rapporteurs, Independent Experts and Working Groups are part of what is known as the Special Procedures of the Human Rights Council. Special Procedures, the largest body of independent experts in the UN Human Rights system, is the general name of the Council's independent fact-finding and monitoring mechanisms that address either specific country situations or thematic issues in all parts of the world. Special Procedures' experts work on a voluntary basis; they are not UN staff and do not receive a salary for their work. They are independent from any government or organization and serve in their individual capacity.

UN Human Rights, country page: Ghana

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"I was a drug user for 16 years – I know how society pressures you and puts you in a tight corner… Some people can’t get a passport, some don't have a place to live, some don't take antiretroviral drugs because they continue using drugs... It is impossible to break out of this terrible circle without outside help,” recalls Evgeny Yuldashev, a social worker and HIV peer counsellor in Kyrgyzstan. 

Currently, he provides HIV prevention and care services to vulnerable groups of people, including people who use drugs.

"There are former prisoners living with HIV who lost their rights to housing while they were serving their sentences”, says Mr Yuldashev. “Some are migrant workers living with HIV who were deported and now have no idea where to start again. It is not easy for sex workers who are constantly subjected to illegal detention. They all need HIV services and they all need support in getting their rights back.”

This coercive legal environment and the violence experienced by key populations impacts the HIV epidemic in Kyrgyzstan because fear stops people from seeking and adhering to HIV prevention, treatment, care and support services.

Ainura Osmonalieva is a lawyer and deputy director of Adilet, the largest human rights and legal services organization in Kyrgyzstan. She says that people are not always ready to defend their rights even when they are told it’s possible.

"We have been providing legal services to key populations free of charge for over fifteen years. Still, there are cases when people from communities come to us, we prepare documents to submit to the court, but at some stage, the person disappears or tells us that he is afraid of the consequences and refuses to take further steps. They may experience tremendous pressure if they decide to go to trial. The main reason in my opinion is the high level of stigma and discrimination that exists in society. "

But when all players are ready to fight till the very end, there can be dramatic change.

With the help of Adilet's lawyers, Kyrgyz' activists managed to remove the barrier to parenting for people living with HIV in the country, which had been in effect for many years. As a result, the Country's Constitutional Court excluded HIV from the list of diseases that prevent people from adopting children or becoming guardians or foster parents.

It took lawyers four years and hundreds of hours of analytical work on the conventions, agreements and declarations ratified by Kyrgyzstan for the Constitutional Court to finally decide the issue.

"We collected the evidence base, then a plaintiff came forward and we were able to file a lawsuit on their behalf," says Ms Osmonalieva.

In July 2021, adolescents living with HIV in Kyrgyzstan who were infected in state medical institutions between 2006—2009 filed lawsuits against the state for compensation for moral damage. Families who had battled for justice for more than a decade were given hope when lawyers won a case and a child was awarded $23,000 in compensation.

The Public Foundation "Positive Dialogue" is another non-governmental human rights organization in the south of the country that provides free legal assistance to vulnerable groups.

"We work closely with the Republican AIDS Center and the Osh Regional AIDS Center to monitor the situation regarding patients' rights, including patients who are in prisons, and conduct assessments of the legal environment to understand what legal norms can be applied," says lawyer Arsen Ambaryan.

According to Mr Ambaryan, all players - state bodies, nongovernmental organizations, and human rights defenders must work as a team to eliminate the legal barriers that still exist in the country.

New global targets for 2025 put a special emphasis on creating the enabling environment for ending AIDS, identified in the 10-10-10 targets: that less than 10% of countries have punitive legal and policy conditions that prohibit or restrict access to services; less than 10% of key populations and people living with HIV face discrimination and stigma; and less than 10% of women, girls, people living with HIV and key populations face violence and gender inequality.

“Kyrgyzstan has a lot of work ahead,” says UNAIDS country director, Meerim Sarybaeva. “It will require consistency from all sides and UNAIDS stands ready to provide any support required in this important area."

Video: Evgeny Yuldashev, a social worker and HIV peer counsellor in Kyrgyzstan, answers questions on how we can protect people who inject drugs