Being a contribution in commemoration of ‘End HIV Stigma Day’ (today, July 21, 2024)
By Alfred Ajayi
HIV, the human immunodeficiency virus, has been more than just a medical condition but also a profoundly sore test of our collective humanity. Since outbreak in the early 1980s, HIV/AIDS has put our empathy, understanding, and willingness to accept fellow humans who are infected and in dire need of acceptance, into scrutiny.
Unending issues of stigma and discrimination across societies, creeds and races worldwide have betrayed our understanding of the shared humanity.
Undoubtedly, HIV in its early days presented an unprecedented challenge with its rapid spread across continents and infecting millions of people. Globally, by the end of the 1980s, the World Health Organization (WHO) estimated that over 250,000 people had died from AIDS-related causes while the United Nations Programme on HIV/AIDS (UNAIDS)’s data, by the mid-1990s, showed that the cumulative number of AIDS-related deaths worldwide had surpassed 1 million
.The early years were marked by fear, misunderstanding, and a desperate search for a cure. The search lingered until the discovery and development of Antiretroviral Therapy (ART), which became pivotal in changing the course of the HIV/AIDS epidemic. While AZT also known as zidovudine or Retrovir, was the first antiretroviral drug, the introduction of protease inhibitors and the subsequent development of the Highly Active Antiretroviral Therapy (HAART) in the mid-1990s were crucial milestones, which significantly improved the life expectancy and quality of life for people living with HIV (PLWHA). While there is yet no cure for the virus, infected persons can fulfill all their life dreams as they live positively with it.
Despite the significant medical breakthrough which has transformed HIV from a fatal diagnosis to a manageable condition with antiretroviral therapy (ART), stigma and discrimination seem far more entrenched and harder to overcome. Stigma remains the first and perhaps the most persistent issue that HIV has brought to the forefront. It is a dual burden on infected persons who combine management of a chronic health condition with an enduring social ostracism.
Discrimination against PLWHA takes the form of social exclusion and denial of healthcare, employment, and housing. In many parts of the world, the stigma associated with HIV is compounded by pre-existing prejudices against marginalized groups, such as the LGBTQ+ community, sex workers, and drug users. These groups are often disproportionately affected by HIV and already face significant social and legal challenges. The intersection of HIV-related stigma with these existing biases creates a toxic environment where prejudice is reinforced and human rights are routinely violated.
In Nigeria, HIV stigma and discrimination are closely linked and mutually reinforcing. Stigma arises from misconceptions about HIV transmission, moral judgments, and fear, leading to discriminatory behaviors such as social ostracism, denial of employment, and inadequate healthcare access for those living with HIV. This discrimination exacerbates stigma, making individuals unwilling to disclose their status or seek treatment, thus perpetuating the cycle of ignorance and prejudice.
Where are the laws?
Issues around HIV stigma have lingered in the face of international and national laws enacted to eliminate or at best reduce them to the barest minimum. The Universal Declaration of Human Rights (UDHR), which states that all human beings are born free and equal in dignity and rights, while everyone is entitled to all the rights and freedoms set forth in the Declaration, without distinction of any kind.
Also, article 26 of the International Covenant on Civil and Political Rights (ICCPR) categorically states that all persons are equal before the law and are entitled without any discrimination to the equal protection of the law, while the International Covenant on Economic, Social and Cultural Rights (ICESCR) in its article 12 recognizes the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
The UNAIDS International Guidelines on HIV/AIDS and Human Rights, published in 1998 and updated in 2006, equally provide a comprehensive framework for creating an enabling environment for HIV prevention, care, and support. Apart from emphasizing the protection of human rights and the elimination of stigma and discrimination, the guidelines equally recommend repealing of punitive laws, policies, and practices, and the implementation of laws and policies that promote equality and non-discrimination.
The Global Commission on HIV and the Law, established by the United Nations Development Programme (UNDP), has produced detailed reports and recommendations aimed at addressing legal and human rights issues related to HIV. Its 2012 report, entitled “HIV and the Law: Risks, Rights & Health,” calls for legal reforms to reduce HIV-related stigma and discrimination and improve access to justice for PLHIV.
There are local laws and policies in Nigeria combating HIV-related stigma and discrimination in areas such as employment, healthcare, and education. Nigeria’s HIV and AIDS (Anti-Discrimination) Act, 2014 eliminates all forms of discrimination against people living with HIV and AIDS (PLHIV).
Its section 3(1) states that no person, community, institution, or organization, whether public or private, shall discriminate, directly or indirectly, against any person based on their HIV status or perceived HIV status in employment, accommodation, education, healthcare services, and other areas of public life. Section 3(2) prohibits discrimination including the denial of access to, exclusion from, or restriction in any benefit, opportunity, or service provided to the public.
The law in its Section 7 (1) states that no employer, employee, or applicant for employment shall be required to undergo HIV testing or disclose their HIV status as a condition for employment or continued employment while section 7(2) prohibits the termination of employment based on an employee’s HIV status.
Section 9(1) gives every person living with HIV the right to privacy regarding their HIV status stating that no person shall disclose the HIV status of another without their consent, except where required by law. Section 9(2) compels healthcare professionals and other service providers to maintain confidentiality concerning the HIV status of their clients or patients. Section 10 (1) of the Act prescribes that every person living with HIV has the right to access healthcare services without discrimination, while Section 10(2) mandates the health institutions and professionals to provide services to PLHIV with dignity and respect for their rights.
In its section 12, the Act emphasizes the importance of providing accurate information and education to the public about HIV and AIDS to reduce stigma and discrimination while Section 15 recognizes the specific needs and rights of women, children, and other vulnerable groups living with HIV, ensuring their protection and access to services without discrimination.
The 2014 Act goes ahead to prescribe penalties for stigma and discrimination. Section 14(1) specifically prescribes a fine of not less than N500,000 (Five Hundred Thousand Naira) for individuals, or N2,000,000 (Two Million Naira) for organizations for discriminating against a person on the grounds of their actual or perceived HIV status. In section 14(2), the court in addition to the fine, may order the convicted person or organization to pay compensation to the victim as deemed appropriate.
According to section 9(3), any person who breaches the confidentiality of another person’s HIV status without consent, except as required by law, is liable on conviction to the penalties specified under Section 14 above same as any person who subjects a person living with HIV to harassment or abuse is liable to the penalties specified under Section 14 of the Act.
Apart from violating basic human rights, discrimination also exacerbates the spread of the virus. When individuals fear testing or seeking treatment due to potential stigma, they are more likely to unknowingly spread the virus and less likely to adhere to necessary medical regimens. With current realities around HIV response across the world and especially in Nigeria, misconceptions fuelling discrimination are only rooted in ignorance and have no place in medicine.
No longer a Death Sentence
Even in Nigeria where the response has largely been donor driven, there have been steady progress as Nigeria has significantly expanded access to HIV testing and treatment services. Millions of Nigerians have been tested with substantial increase in the number of people receiving antiretroviral therapy (ART). As of March 2023, a project under the US President’s Emergency Plan for AIDS Relief (PEPFAR) program reported that 576,171 patients had received antiretroviral treatment (ART) in Nigeria, demonstrating an ongoing commitment to expanding HIV testing and treatment services.
The Nigerian government has equally implemented the National HIV/AIDS Strategic Framework (2017-2021), which aims to achieve the UNAIDS 90-90-90 targets: 90% of people living with HIV knowing their status, 90% of those diagnosed receiving sustained ART, and 90% of those on treatment achieving viral suppression. That has been scaled up to 95-95-95 which targets to achieve similar goal at higher percentage by 2030.
There has been a notable decline in new HIV infections due to enhanced prevention efforts, including education, condom distribution, and programs targeting key populations at higher risk. However, recent data indicate that Nigeria has one of the highest rates of new HIV infections globally, with approximately 190,950 new cases reported each year. This high rate makes Nigeria the country with the second highest number of new HIV infections in the world.
The country has equally made strides in preventing mother-to-child transmission of HIV, with increased access to prenatal care and ART for pregnant women, which significantly reduces the risk of transmitting HIV to their babies. Various community-based initiatives and partnerships with non-governmental organizations (NGOs) have been crucial in raising awareness, reducing stigma, and encouraging voluntary testing and treatment.
Mobile testing units and home-based testing have made it easier for people to know their HIV status and seek treatment without fear of stigma. Continued support from the Nigerian government, international organizations, and donor agencies has strengthened the national response to HIV, providing the necessary resources and expertise to combat the epidemic effectively. However, the percentage of local funding of HIV response is still a concerning issue.
They Deserve Our Empathy and Understanding
We must view the statistics about HIV as humans who deserve a good life like any of us. We must intentionally empathize with them and listen to their stories to understand their struggles, and to advocate for their rights. Empathy also requires that we educate ourselves and others about HIV, dispelling myths and replacing our fear with facts. We must look beyond stereotypes to collectively address stigma and discrimination. This is crucial to encouraging open communication and improving public health outcomes.
The positive outcomes in terms of prevention, treatment, and support recorded so far are not divorced from compassionate responses to HIV. Community-based organizations, activists, and healthcare providers who approach HIV with empathy and understanding have made a tangible difference in the lives of millions.
Time to embrace humanity
We must generally as a people adopt a humanitarian approach to HIV response. We must not allow fear and prejudice to dictate our responses. The lingering stigma and discrimination associated with HIV suggest that while we have made progress, much work remains. Prejudices which fuel stigma and discrimination must be sustainably challenged.
This requires amendment to laws and policies as well as shifting cultural attitudes. It compels us to create a safe environment where people feel free and encouraged to seek testing and treatment, where their rights are protected, and where they are not defined by their HIV status. By addressing the stigma and discrimination, we not only improve the lives of those affected by the virus but also reaffirm our commitment to human dignity and equality.
The 2023 UNAIDS Global AIDS Update shows interesting improvement in HIV response across the world. New infections reduced by 49% between 2010 and 2022, while treatment coverage increased from 36% to 82%. In 2022, 71% of persons living with HIV (PLHIV) got virally suppressed. These encouraging statistics should discourage stigma and discrimination. Rather, we must popularize free HIV testing among the populace and stand by those who are positive to go through the treatment regimen and live positively with the virus.
On this special day marking Zero HIV Stigma Day, we must see humanity in every HIV infected person. We must embrace them and show them love. Make a commitment today to give such a one a reason to live.
In line with the theme for this year, which is “Beyond Labels: Redefining HIV Narratives,” we must all resolve to stop the discriminatory and undignifying labelling of those living with HIV.
Stop the stigma. Stop the discrimination. Embrace humanity.
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