B5gv9

The major causes
of stigma are
lack of depth in
HIV and AIDS
knowledge,
attitudes toward
sexual behaviour
and perception of
immoral activities
and care. Stigma refers to a negatively
perceived defining characteristic used
to set persons apart from the dominant
majority. Discrimination acted upon
through ostracising, shunning or rejecting
others (Busza, 1999), has tended to fall
into two basic categories – legislative
and community-level. Societal-level
discrimination such as through media
constitutes a third level. Public health
history is laden with examples of stigma
and discrimination impeding individual
health: individuals with leprosy, cholera
and syphilis faced prejudice and
discrimination similar to that seen today
with HIV and AIDS (Valdiserri, 2002).
In India, since the first diagnosed case
in 1986, perceptions of the epidemic
have largely labelled it as a sickness
of others: the marginalised, the poor
and the vulnerable. Several states have
proposed HIV protection bills that would
require mandatory reporting or partner
notification – actions deemed as potential
violations of individual rights in many
countries. Further, in 1998 the Supreme
Court of India suspended the right of
PLWHA to marry; after considerable
activism, the right was restored in 2002
(Lawyers Collective, 2003). The National
AIDS Control Programme recognises
the obstacles caused by stigma and
discrimination and emphasises the need
for respondent measures.
The major causes of stigma are lack
of depth in knowledge about HIV and
AIDS, attitudes toward sexual behaviour
and perception of immoral activities.
Of the limited number on studies of the
social reaction to AIDS, all document
an overwhelmingly negative response
to PLWHA in India (Bharat et al, 2001).
The degree to which stigma is applied
may vary based on perceived fault for
contracting the infection. In the Indian
context, sex workers and men who have
sex with men and injecting drug users
may be branded as carriers of the virus.
However, research has also shown bleak
circumstances for women infected by
spouses and children of HIV-positive
parents.
Fear of prejudicial treatment can be
a major reason for not being tested.
Further, studies in India illustrate that
PLWHA cite fear of discrimination as
a primary barrier to disclosing their
positive HIV status. A study in South India
demonstrates that even among those
who disclose their status, the majority
limited it to immediate and to a lesser
extent, extended family (Chandra et al,
2003), which is found to be the case in this
survey too. Worldwide, studies in America
and Africa reveal persistent attitudes
of fear or discrimination towards HIVpositive
individuals. One in five American
adults fears persons with AIDS (Valdiserri,
2002). In Botswana – the country with the
highest HIV prevalence – a majority of
respondents expressed discrimination
toward a teacher or shopkeeper with
HIV, while not toward a family member
(Letamo, 2003).
In India, research has documented
discrimination in the family, hospitals,
community and at the workplace. Notably,
women face more discrimination than
men (Bharat et al, 2001; ILO, 2003).
The healthcare setting has emerged
as the most often encountered place
of discrimination, followed by familial
and community contexts. Forms of
discrimination in hospitals include refusal
of treatment, discriminatory precautions
and lack of confidentiality. Doctors often
refuse to aid in the delivery of a positive
pregnant woman despite minimal risk of
contracting the infection (ILO, 2003). In
a study in Mumbai and Bangalore, many
healthcare providers and facilities were
found to deny care, treat patients poorly
6
Socio-Economic Impact of HIV and AIDS in India