HIV- related stigma hinders access to healthcare
HIV stigma threatens access to vital services in Botswana, hindering prevention, testing, treatment and support for those a ected. e just released Stigma Index 2.0 Study acknowledges that though signi cant progress has been made to reduce HIV- related stigma and discrimination in the response to HIV due to persistent negative attitudes towards people living with, at risk of and a ected by HIV, stigma and discrimination remains a challenge.
According to Dr Daniel Rakgoasi, a Consultant from the University of Botswana, who was part of the team that conducted the study throughout the country, internal or self- stigma is a much bigger problem compared to external. He said the youth particularly, battle with internal stigma.
Dr Rakgoasi said within external stigma, most respondents were bothered by other people making discriminatory remarks, particularly family members, with some reporting being excluded from family activities as a result of their HIV status.
According to Dr Rakgoasi, in general disclosing HIV status has become easier over time, with some reporting that they received overwhelming support from friends and family once they disclosed their status.
More respondents viewed voluntary disclosure of HIV status as a very important step towards self- acceptance and resilience. In fact, it was the view of some that while HIV stigma is a real issue, the bigger problem comes from internalised stigma as resulting ideas that one has about their status.
Disclosure was also seen as an important precursor to enrolment or treatment and accessing and utilising the bene ts of support networks and structures of people living with HIV. e Study, which was done in collaboration with Botswana Network of People Living with HIV and AIDS ( BONEPWA+), National AIDS and Health Promotion Agency ( NAHPA), UNAIDS and the Global Network for People Living with HIV, revealed that the presence of Infectious Disease Control Centres ( IDCC) clinics and their lack of integration with other services, was perceived as an inadvertent disclosure of HIV status for those who must access the IDCC clinic.
It states that people who are still struggling to accept their status might nd it di cult to access IDCC services and this will create propensity for non- adherence to treatment, and reluctance to access support structures and networks for people living with HIV.
One respondent said, “Here in Botswana there is no secret, even when you go to the hospital, you will hear them saying, ‘ who is here for re ll?’ Even the security guard will be busy shouting, ‘ Re ll!’ and imagine people will be just looking at you, imagine if there are relatives or customers that you do not want to know your status.”
Another said, “It’s hard when you are a business lady because I know that they will no longer buy from you thinking that you are sick.”
Another respondent said, “It is not easy to open up about my status to everyone. Opening up can be such a hectic thing. You tell someone that you are living with HIV, before you know it, everyone knows about your status. So I will rather use protection and keep my status secret.”
According to Dr Rakgoasi, there is an urgent need to develop and strengthen legislation and enforce policies and legislation that can assist in eradicating existing forms of stigma and discrimination against key populations and vulnerable groups, as well as people living with HIV. Further, that clear de nitions and provisions that explicitly prohibit discrimination based on HIV status, sexual orientation and gender identity among others should be included.
He added that there is need to establish robust enforcement mechanisms to ensure compliance with anti- discrimination laws, including e ective monitoring and reporting systems. “Allocate adequate resources for law enforcement agencies to investigate and prosecute cases of discrimination e ectively.”
e study also recommends promotion of public campaigns to raise awareness about the importance of anti- discrimination laws and the rights of people living with HIV and key populations. Further, the study recommends establishment of Rights- based healthcare services. ese would implement training programmes for healthcare providers to promote a non- stigmatising approach in all health services, including HIV- related ones. ese would also enforce strict policies against discrimination based on drug use or HIV status within healthcare settings, and provision of accessible and con dential HIV testing, treatment, and care services without fear or judgment or discrimination.
Dr Rakgoasi said the study recommends enhanced and intensive healthcare worker training to ensure that health workers understand and implement human rights principles in their practice.
Other recommendations include, conducting sensitisation programmes targeting in uential community gures, incorporating human rights education into community leader training manuals to drive change in societal norms. In addition, aggressive mobilisation of resources to support public education and dissemination of information on rights, laws and policies a ecting people living with HIV and key populations. e rst Stigma Index study was conducted in 2013 and highlighted the need to improve access and utilisation of HIV services.
At the time, people living with HIV experienced various forms of HIV- related stigma and discrimination. ey felt shunned by family, peers and the wider community. ey also received poor treatment in health care and education settings, experienced judgemental attitudes, insults and harassment.