EXPLORING THE WORLD OF STRUCTURAL STIGMA: HOW CAN LAWS AND POLICIES REINFORCE HIV STIGMA?

While it may now be commonly accepted that a lack of respect for human rights can accelerate the HIV epidemic, this isn’t always reflected in the policies and institutions that shape the lives of people living with HIV.

Under international human rights laws and treaties, every person has a right to health and to access HIV treatment and other healthcare services. However, many people affected by HIV face infringements to these rights that can lead to barriers in accessing life-saving services and achieving a good quality of life.

Through the Positive Perspectives study, we sought to understand the world of Structural Stigma; exposing its impact on people living with HIV and considering what more needs to be done in order to overcome it.

What do we mean by ‘structural HIV stigma’?

Structural stigma refers to any form of law or policy which results in the creation or reinforcement of HIV stigma. Structural stigma can exist at a global, national, state or regional level and includes any law or policy - including legislative frameworks and governmental policy.

A short history of the fight against Structural Stigma.

At the 2016 UN high-level meeting on Ending AIDS, member states adopted the ‘Political Declaration on HIV and AIDS: On the Fast Track to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 2030’ document.

Countries signing this declaration pledged to ‘intensify efforts towards the goal of comprehensive prevention, treatment, care and support programmes that will help to significantly reduce new infections, increase life expectancy and quality of life, and promote, protect and fulfil all human rights and the dignity of all people living with, at risk of, and affected by, HIV and AIDS, and their families’. 

…We all have a responsibility to do what we can to remove stigma and discrimination around HIV…. challenging any negative attitudes or assumptions towards those living with this condition.

Statement by Justin Trudeau, the Prime Minister of Canada, on World AIDS Day, December 1st, 2016

Despite this declaration and other progress at a supra-national level, it takes time for changes – both attitudinal and legislative – to percolate through to changes in laws and policies. Today, there remain infringements to the human rights of people with HIV; which can lead to barriers in accessing life-saving services and achieving a good quality of life.

Human rights infringements can include: laws that criminalise people living with HIV based on their HIV status (e.g. for non-disclosure of status); criminalisation criminalisation based on sexual orientation, gender identity or profession; discrimination in the workplace; gender inequality exacerbated by HIV; and lack of access to healthcare services amongst others.

I was sentenced for HIV non-disclosure.

35–49-year-old man, Canada

Key findings from the Positive Perspectives study

The Positive Perspectives survey, through insights from respondents, highlighted some of the issues that remain with legislative frameworks, for example: 

The stigma and criminal law around HIV has not changed much at all since the beginning. That’s 30 plus years and stigma and criminal law [is] still the same, especially in rural areas.

50–plus woman, USA

Even in countries where there are strong antidiscrimination laws, we cannot assume that laws will be enforced or that good practices and equality follow.

What can be done to bring about change?

A human rights-based response is now widely recommended to address HIV stigma and discrimination in the public policy and legislative domain, which includes human rights laws and treaties, political declarations and human rights principles in HIV programming.

1. Zero discrimination in legislative frameworks. Existing legislation that contravenes human rights and/or discriminates against vulnerable groups should be repealed. Furthermore, the enforcement of existing legislation, and the prosecution of criminality associated with physical and verbal abuse based on actual or perceived HIV status, is critical.

2. Independent committees to ensure zero discrimination. Where they don’t already exist, we call for the setting up of independent committees – with representation from people living with HIV – to scrutinise governments and their representative bodies, including healthcare systems, to ensure no inherent prejudice or discrimination is influencing funding and/or policy decisions. A defined complaints procedure for cases to be referred to, should be in place.

Our work towards combatting structural stigma

Through the Positive Action programme, funding is being provided to community based organisations for “know your rights” campaigns and advocacy in addressing human rights related barriers.