Stigma, discrimination hamper campaign against HIV

ASHA (not her real name), a 16-year-old teen living with HIV, says when she was in Form-III in one of the schools in Mjini District, she decided to expose her health status to her teacher who demanded to know why she was frequently asking for permission to go to hospital.

Probably it was a big mistake to tell the teacher that she was HIV positive as he passed the message to other teachers resulting to stigmatisation. Four-year-old boy at a kindergarten in Wete District, North Pemba Islands was also stopped to attend school after teachers realised that he was living with HIV.

Another Kindergarten pupil of the same age in the same district was discriminated by his colleagues during class and break time after learning he was HIV positive.

“It was sad to be isolated by my colleagues and my teachers because I am living with HIV. I was physically fine and loved to play with friends, but they discriminated me in all activities including sitting in classroom,” Asha narrated, the life many people like her are still experiencing despite ongoing efforts to fight stigma and discrimination.

Similar stories are still being heard from people of all ages, living with HIV, almost everywhere. According to the Tanzania HIV Impact Survey (THIS) 2016-2017, prevalence among adults aged 15-49 years was 4.7 per cent for the entire country [4.8 per cent in Tanzania mainland and 0.4 per cent in Zanzibar.]

HIV prevalence among females aged 20-24 years, 25-29 years, 30-34 years, and 35-39 years was higher than in males in corresponding age groups, and the survey indicated that the burden of HIV infection varies across the country- the prevalence ranged from less than 1.0 per cent in Zanzibar and Lindi to 11.4 per cent in Njombe.

The Awareness Manager of the ‘Zanzibar Aids Commission (ZAC), Mr Saadat Haji, says that although in overall, HIV prevalence has declined with increased education level for both males and females, stigma and discrimination are still challenges that hamper campaign to control the spread of HIV.

“We have been struggling hard to maintain and reduce further prevalence in the country so that we can beat the 90-90-90: ambitious global HIV programme targets proposed by UNAIDS and adopted by each country, but stigma is a problem,” says Haji.

The target was that at least by this year (2020), 90 per cent of all people living with HIV (PLHIV) will know their HIV status; 90 per cent of all people with diagnosed HIV infection will receive sustained antiretroviral therapy (ART); and 90 per cent of all people receiving ART will have viral load (VL) suppression (VLS).

It is behind this background that Amref Health Africa Tanzania is supporting programmes that aim to increase awareness among the population so that stigma is minimized. ZAC is one of the implementing partners in Zanzibar.

Among the government efforts to reduce HIV/AIDS stigma is providing care and free HIV treatment services, while Amref and ZAC are encouraging journalists and the media to help address the problems of stigma and discrimination by running programmes or publish articles that will result into behaviour change.

The role that stigma plays in increasing the spread of HIV has been identified in the Tanzanian Policy on HIV/AIDS, and the Health Sector HIV/AIDS Strategic Plan IV (HSHSP 2017-2022). Stigma reduction is recognised as a key guiding principle that must be addressed by all sectors at all levels.

‘THIS’ revealed that stigma and discriminatory attitudes towards People Living HIV (PLHIV) are higher in Zanzibar (23.4 per cent) compared to Tanzania Mainland (19.7 per cent), and that the problem is bigger in Pemba Islands (38 per cent) compared with Unguja (18.6 per cent).

Discriminatory attitudes were also higher among those who lived in rural areas, had lower level of educational attainment, and were in lower wealth quintiles, Haji from ZAC said as he urged journalists to work closely with his office to reduce stigma burden.

Drivers of stigma have been previously identified as lack of recognition of stigma; fear of acquiring HIV through casual contact; and values linking people with HIV to assumed immoral behaviour.

Ms Hasina Hamad from ZAC information department says survey indicates stigma embedded in work place, which include condition to test for HIV before employment, reply of no job or being denied job promotion after testing positive.

“We also have cases of stigma and discrimination hospitals by some unethical medical practitioners such as revealing patient’s HIV status and compulsory testing or forced HIV check-up; and also in religious institutions where people with HIV are sidelined and blamed,” Ms Hamad said.

She said stigma has multiple negative effects on health outcomes, including non-optimal medication adherence, lower visit adherence, higher depression, and overall lower quality of life, cause of deaths, fear to test and reveal status, and abandoning treatment.

HIV-related stigma refer to negative beliefs, feelings and attitudes towards people living with HIV, their families, people who work with them (HIV service providers), while HIV discrimination refers to the unfair and unjust treatment of someone based on their real or perceived HIV status.

HIV discrimination is often fuelled by myths of casual transmission of HIV and pre-existing biases against certain groups, certain sexual behaviours, drug use, and fear of illness and death. Discrimination can be institutionalised through laws, policies, and practices.

Ms Saada Mussa- Lawyer says ‘the prevention and management of HIV and AIDS in Zanzibar Act No 18 of 2013’ protects and promotes Human Rights of Person living with or affected by HIV and AIDS, but the implementation and enforcement of the law remain low.

On Zero Discrimination Day, which is commemorated every year on March 01, UNAIDS calls for an end to discrimination against women and girls and for equal rights, opportunities and treatment.

It is observed that despite progress in some areas, in 2020 coercive practices, discriminatory legislation and gender-based violence are just some of the human rights violations that are continuing to have a disproportionate impact on the lives of women and girls around the world.

UNAIDS highlights areas where change is urgently needed: equal participation in political life; human rights and laws that empower; economic justice- equal pay for equal work; ending gender-based violence; provide health care without stigma or barriers; equal and free access to primary and secondary education; and climate justice.

Article first published on https://www.dailynews.co.tz/news/2020-03-245e7a0e70a91a5.aspx