HIV/AIDS and development work

There has been progress in combating HIV/AIDS with massive reductions in mother to child transmissions and wider availability of treatment.  However, in 2018, 1.7 million people became infected.  Apart from problems with the complexity and cost of treatment, those who live with HIV/AIDS are often stigmatised, contributing to social exclusion. This article explores the links between HIV/AIDS and poverty, why HIV/AIDS can contribute to social exclusion and some strategies for improvement.

Poverty and HIV/AIDS

HIV/AIDS can worsen poverty in the same way that any health condition can, by preventing people from working, and increasing healthcare costs. But also, discrimination can deter people from seeking diagnosis or treatment.  There is also evidence that HIV/AIDS is more prevalent among the absolute poor for several reasons including; poor access to education and health care and a lack of power to negotiate safe sex (especially among women) and not enough money to buy condoms.

Types of HIV related stigma

The most common forms of HIV related stigma are:

• Physical stigma like isolation and violence.
• Social isolation and loss of identity.
• Verbal stigma.
• Institutional stigma that includes loss of livelihood and housing or differential treatment in public settings.

Why the stigma?

There are many prevalent diseases, so why does HIV/AIDS carry a particularly strong stigma? The charity AVERT suggest several reasons:

It’s a relatively new and life-threatening disease which creates fear.

It can be associated with behaviours that are already stigmatised, or even criminalised, in many places, such as homosexuality, drug use, sex work and multiple sexual partnerships. Therefore, the person who has the disease is seen to be guilty in some way and blamed, often using moral or religious arguments.

There are a lot of myths about how HIV is transmitted.

Antiretroviral drugs can affect people’s appearance which leads to discrimination.

In Sub-Saharan Africa, the most common transmission of HIV is through heterosexual sex, so stigma is often focused on multiple sex partners and sex work.

Stigma can be reinforced by several factors:

• Government: 71% of countries have some law to prevent discrimination against people living with HIV/AIDS, but often contradict these with other laws. For example, compulsory testing, expulsion from the military and prosecution for unintentional transmission.
• Healthcare: There are tests done without consent and a lack of confidentiality. Sometimes patient are treated poorly, which is fuelled by medical staff’s fear of catching HIV.
• Employment: Some companies will fire or not employ people with HIV/AIDS.
• Restrictions on travel: 47 countries place restrictions on the travel of people with HIV/AIDS.
• Community: There can be verbal and physical abuse and even murder. Sometimes family members withdraw their care of people with HIV/AIDS due to fear of possible social and financial repercussions.

How can we move forward?

A first step is ensuring all programmes, projects and plans are inclusive of people with HIV/AIDS. The GIPA principle (Greater Involvement of People Living with HIV and AIDS) means people living with HIV and AIDS are fully consulted and involved in decision-making processes, policy and programme implementation.

Common interventions around HIV and AIDS include:

• Prevention: Providing, for example, free access to condoms.
• Campaigning for universal treatment: Studies in Tanzania and Botswana showed a decline of the stigma attached to HIV/AIDS as treatment was made universal.
• Education: For example, The Aids Alliance run peer group activities with safer sex education and skills building for prevention.
• Legal protection: As well as protection from discrimination, laws should not directly or indirectly discriminate against people with HIV/AIDS.

The Aids Alliance take a combination approach looking at behaviour change, medicine and the wider environment (legal, community, etc.).

How can you make a difference?

Given the reasons explored here for social exclusion of people living with HIV/AIDS:

• What actions could you take, that might encourage inclusion and lessen discrimination?
• How can projects such as yours ensure people living with HIV and AIDS are decision-makers in activities aimed at them?