Stigma, discrimination could derail the HIV fight

Rumbidzayi Zinyuke

Health Buzz

After decades of fighting against HIV and AIDS, and making good progress, Zimbabwe could be faced with a major challenge that could derail the gains so far made.

Identifying people with HIV and initiating them on treatment has seen the country getting recognition for being on track to attaining the UNAIDS 95-95-95 targets to end AIDS by 2030.

But discrimination and stigma against people living with HIV has been gradually increasing.

According to a recently launched Zimbabwe Stigma INDEX 2.0 Report, stigma and discrimination in the country has risen to 69,7 percent from 65,5 percent recorded in the 2014 Stigma Index report.

The People Living with HIV (PLHIV) Stigma Index is a standardised process of gathering evidence on how stigma and discrimination impacts the lives of people living with HIV. 

The new report showed that the highest number of respondents who stated that they had experienced stigma related to their HIV status were those who identified as transgender, sex workers and men who have sex with other men.

Participants were asked to state whether they had experienced problems when accessing HIV specific health care. Notably, 10 percent of 138 respondents reported that they had experiences of being talked badly about or gossiped about because of their HIV status.  

A total of 37 reported that they had suffered physical abuse from the health service providers which included pushing and hitting among other abuses, while 7,7 percent said other people spoke about their HIV status without their consent. 

About 9,9 percent said people had gossiped about their HIV status and 4,1 percent reported that people had avoided physical contact with them because of their HIV status.

Speaking at the launch of the report, Health and Child Care Deputy Minister Dr John Mangwiro said it was imperative that all stakeholders join the fight to end all forms of discrimination against people with HIV.

“Zimbabwe has always been a trailblazer in the response to the HIV epidemic but stigma continues to hamper our efforts in some areas. Only urgent action to tackle HIV related stigma can ensure that the response is on track. We need to end stigma for all people living with HIV in their diversity and marginalised communities,” he said.

He called for the strengthening of a multi-sectoral approach to renew and commit to ending stigma and discrimination if the country was to reach the target to end AIDS as a public health threat by 2030.

Dr Mangwiro said while stigma and discrimination was real, a lot of it was self-imposed stigmatisation which needed to end.

Zimbabwe recently received an accolade from the United States President’s Emergency Plan for AIDS Relief (PEPFAR), recognising it as one of the only three countries in Sub-Saharan Africa on track to attain the 95-95-95 HIV objectives ahead of timelines set by the Joint United Nations Programme on HIV/AIDS.

According to statistics from the National Aids Council, by June last year, 96 percent of people living with HIV knew their status, while 97 percent of those who knew their status were on treatment. 

Of those people on treatment, 95 percent of them were virally suppressed meaning the medication they were taking was working to suppress the HIV virus.

However, the fact that stigma and discrimination remains high despite these impressive statistics is indeed worrying.

Hence the need to come up with solution to this emerging problem.

For the country to achieve its goals, the report made several recommendations that were expected to help overcome the discrimination and stigma.

It recommended for the Ministry of Health and the National Aids Council to use existing structures to widely disseminate the study results to all the participating districts and all stakeholders and communities countrywide.  

Since reported stigma was highest in the urban centres, there should be targeted awareness campaigns for the cities.

“Disseminating findings on the experience of stigma by PLHIV should be a priority in all sectors of the Zimbabwean economy including but not limited to government agencies, the private sector, educational sector, workplaces, health institutions, and the generality of the population,” the report said.

“NAC in collaboration with CSOs should run programmes such as straight talk on radio and television, for young people living with HIV and key populations to discuss ways of mitigating stigma and discrimination. There is also need to include HIV related stigma and discrimination indicators as part of Zimbabwe’s HIV Response monitoring and evaluation systems to monitor and evaluate progress over time.”

Due to the rise in the overall experience of stigma among PLHIV in Zimbabwe, the report stated that there was need to develop and roll-out strategies and guidelines with a specific focus on key issues such as HIV status disclosure in all settings such as the workplace, learning institutions, the community, prisons, and health-care institutions.

There was also need for continual sensitisation of key sectors of the society such as law enforcement agents, religious leaders, community gatekeepers, the media, and healthcare service providers on anti-stigma and anti-discriminatory strategies and actions.

Seeing as communities can play a pivotal role, the setting up and supporting of community and PLHIV-led monitoring mechanisms meant to monitor and mitigate HIV-related stigma and discrimination was highlighted.

For many people living with HIV, disclosure of status to family remains a serious problem as many do not find it easy.

The report stated that promoting and encouraging HIV status disclosure to intimate partners and within families would foster adherence and informed decision making.

“Since the majority of respondents reported that they faced discriminatory practices within their own families and the society at large, there is need to institute measures to address stigma and discrimination among PLHIV as there is evidence that respondents in this study were subjected to gossip, verbal abuse, exclusion from social gatherings, and physical abuse due to their HIV status,” read the report.

Increasing community sensitisation and mobilisation programs could also help to deliver key messages that discourage HIV related stigma in the communities while dispelling myths and misconceptions associated with HIV and AIDS at different levels of the community.

There is also need to increase commitment in combating stigma affecting key populations such as the LGBTQI, prisoners, people with disabilities, and men that have sex with men (MSM) who are usually faced with more stigma.

Research is also integral in the fight against HIV and AIDS.

The report notes that there is need to conduct further research especially of a qualitative nature which would help bring to the core a deeper understanding of how stigma occurs in PLHIV in varying socio-cultural settings within Zimbabwe.

This research should include the implementation of cost-effective and culturally appropriate interventions to reduce stigma and discrimination for PLHIV, the occurrence of stigma in institutions such as schools, universities, workplaces as well as on migrant workers.

The fight against HIV and AIDS is not for Government alone. 

Neither is it only for the people living with HIV.

 But a coming together of all stakeholders will definitely yield the desired outcomes of ending the HIV pandemic and the stigma and discrimination that surrounds it.

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