Panel on Exploring the link: HIV/AIDS, stigma, discrimination and racism;Speech by Peter Piot,Executive Director, UNAIDS

5 September 2001



The International Response to AIDS and Discrimination


Mary Robinson, friends and colleagues on the panel, ladies and gentlemen,

May I pay tribute to Mary Robinson and to the whole of her Office for the outstanding - and long-standing - commitment they have made to tackling HIV-related discrimination.

The Office of the High Commissioner for Human Rights is not one of the UNAIDS cosponsoring organizations - the seven bodies that together with the Secretariat make up the joint United Nations programme on HIV/AIDS. But that has not stopped us collaborating: our joint International Guidelines on HIV/AIDS and Human Rights continues to be in demand as a fundamental resource for national planning.

As I said in the plenary session of the conference yesterday, nothing better illustrates the continuing destructive force of discrimination, intolerance and stigma in the world today than the global AIDS epidemic.

HIV stigma comes from the powerful combination of shame and fear. Shame because the sex or drug injecting that transmit HIV are surrounded by taboo and moral judgement, and fear because AIDS is relatively new, and deadly.

Responding to AIDS with blame, or abuse for people living with AIDS, simply forces the epidemic underground, creating the ideal conditions for HIV to spread. The only way of making progress against the epidemic is to replace shame with solidarity and fear with hope.

Unequal access to life saving HIV-treatments is one of the most glaring global examples of gross discrimination. For the great majority of people living with HIV, treatments that have slashed death rates in wealthy countries are simply out of reach. Their right to health is undermined on a daily basis for as long as this inequity continues to exist.

Intolerance is a mobile force. It attaches new fears to old forms. This it what makes it hard to pin down and hard to resist with rational argument - the grounds of racism and intolerance keep shifting. HIV-discrimination attaches itself to pre-existing stigmas - to racial stereotypes or to stigma against sexual minorities.

The spread of HIV is linked to racism, poverty, intolerance and inequality because HIV transmission is not only about immediate risk, it is also about underlying vulnerability. And once the epidemic takes hold, the impact of AIDS compounds existing inequality.

All over the world, we have seen HIV affecting rich and poor, white and black, men and women. But over time, the people who have been worst affected are the most disadvantaged, whether on racial, gender or economic grounds. We don’t need conspiracy theories or complicated hypotheses about racial differences to explain this: it is the straightforward consequence of inequality and social exclusion.

There are examples from across the world where HIV-stigma has compounded pre-existing stigma and discrimination:
- In Canada, Aboriginal women with HIV routinely find their needs ignored and rights violated in ante and post-natal care.

- Long-standing discrimination against the Garifuna people on the Caribbean shores of Central America restricts their access to health services, and makes them reluctant to test for HIV for fear of attracting further stigma.

- With two thirds of new AIDS cases among African American and Latino populations, the US is having to find ways to respond to the intersection between race, sexuality and injecting drug use.

- In Belgium, HIV patients from Central Africa feel shut out from prevention and care services, and across Europe the response to the epidemic is grappling with increasing demographic complexity.

- In southern Africa, the colonial and apartheid legacy of work migration requires comprehensive AIDS responses addressing mine workers, sex workers, and communities.

The UNAIDS studies from India and Uganda we are releasing today provide more evidence of people in marginalized groups suffering double doses of discrimination. Women and children have problems with inheritance, care giving and housing. Schools, insurance and funeral services discriminate. Religious leaders give inconsistent messages. Laws are insufficient to protect people with HIV.

But there is also a message that progress is possible. In Uganda, for example, the study found that people with HIV are becoming accepted as a normal part of society and as a result stigma and discrimination are being rolled back.

Shame and fear can be defeated, the chains that link HIV to racism and inequality can be broken and the HIV epidemic can be turned back.

Within UNAIDS - including all our cosponsors - we have taken a three-pronged approach to attacking stigma and discrimination:
- First, advocating strong national and global leadership
- Second, working to protect the human rights of people living with HIV/AIDS and
- Third, promoting the greater involvement of people living with or affected by HIV/AIDS.

To break through stigma and discrimination, we have to think beyond our usual boundaries. Let me take five areas critical to success in defeating HIV-related discrimination.

One: health and social services have to be sensitive to discrimination, and act against it.

In India, the Lawyers Collective in Mumbai has not only been raising awareness among people with HIV of their legal rights, including as patients, they have also been sensitizing doctors and other health care workers to HIV-related legal and ethical issues. And Horizons in New Delhi has been working to create ‘HIV patient friendly hospitals’.

Sexual and reproductive health services need to become both youth-friendly and girl-friendly - one of the aims of a major programme in Africa being conducted by UNAIDS cosponsor UNFPA

Two: voluntary counselling and testing is the entry point to care and treatment, but it is also the point at which individuals are at their most vulnerable and most sensitive to stigma.

The groundbreaking publication last year of guidelines from UNAIDS and WHO on beneficial HIV disclosure and partner counselling has helped to established a coherent and ethical framework for this most sensitive of issues.

Across the world, voluntary counselling and testing is being expanded, and at the same time becoming more sensitive to discrimination: India’s National AIDS Control Organisation is promoting voluntary counselling and testing centres; the Chris Hani-Baragwanath Hospital in Soweto is pioneering community outreach and the expansion of VCT; UNAIDS, in particular WHO, is integrating HIV education and counselling into primary health care in Rwanda, and especially gearing them to the psychosocial needs of young women who have been the victims of rape.

Three: protection from discrimination must become a true multisectoral issue.

For example, the International Labour Organization has recently brought out a new code of practice on HIV and the world of work. Workplace HIV discrimination has been a focus in many countries, including here in South Africa, where the Employment Equity Act has made it illegal for the majority of Government departments to carry out pre-employment HIV testing.

South Africa has also seen cases taken to the highest level courts dealing with unfair dismissal and discrimination against HIV positive people in prisons, supported by the AIDS Law Project at the University of Witwatersrand.

UNAIDS has supported Thai Labour Ministry efforts, supported by international hotels, to provides vocational and life-skills training to young women. Ethiopia’s Save Our Generation association has made providing work skills and integral part of its HIV programmes.

Four: there has been a sea-change in recent months in the global commitment to ensure prevention and care are scaled up in developing countries - and the new Global AIDS and Health fund will help bridge the resources gap.

As well as attacking one of the most severe forms of discrimination currently suffered by people with HIV - lack of treatment access - this new environment creates new opportunities to address discrimination from the ground up in new infrastructure and new services. Vaccines are a case in point - planning has to start now so that any eventual HIV-vaccine will not be rolled out on a discriminatory basis - something already being addressed in the South African AIDS vaccine initiative.

Five: responses to the AIDS epidemic have to ensure that they do not inadvertently promote stigma. The World Food Program, for example, is making sure that it targets communities in need as a result of the impact of HIV, rather than singling out families affected by AIDS. Equally, in education and orphan support, programmes need to avoid further stigmatizing those children who are AIDS-affected.

Condom promotion, life-skills and peer education also have to be conscious of discrimination: are they reinforcing girls’ disadvantage, or tacking it; where do racial stereotypes get addressed; and are they including sexual minorities?

Micro-finance is another area which has to carefully combat and not perpetuate discrimination: the International Labour Organisation for example is strengthening micro-finance and entrepreneurial skills among women in Malawi, Mozambique, Tanzania and Zimbabwe, integrating AIDS education into the programme.

Defeating HIV-related discrimination needs broad action, but it also needs a focus on the tasks and actions that will make an immediate difference. Let me conclude by nominating five.

First: leaders at all levels need to challenge visibly HIV-discrimination, spearhead public campaigns, and speak out against the multiple discriminations that poor people, women, ethnic minorities and gay men face in relation to HIV/AIDS. National leaders have a particular responsibility in setting the appropriate tone for these campaigns, and their actions in embracing people with HIV are often worth a thousand billboards.

Second: there is a need to document HIV-related violations of human rights and conduct public inquiries into them, using existing human rights conventions and mechanisms. UNAIDS has been actively working on this with local and international non-governmental organizations, particularly ICASO, as well as with national human rights institutions, for example in Ghana, India and South Africa.

Third: support groups of people living with HIV and ensure both that they have access to mechanisms to redress discrimination and that they are fully involved in the response to the epidemic.

Fourth: ensure that a supportive legislative environment exists so that discrimination can be tackled, in relation both to the impact and spread of the epidemic.

And fifth: services that have an impact on people affected by HIV need to be made accessible to all parts of the population, and make particular efforts to overcome the barriers of racial, gender and other discrimination.

Building a response to the HIV epidemic grounded in respect, dignity and human rights is not only the right thing to do, experience over the past twenty years tells us it is also the only pragmatic, practical solution to containing the spread of the epidemic and alleviating its impact.

The global HIV epidemic is the great unfolding tragedy of the twenty-first century, but we have the power to change the course of history. We only have to look around at this conference and at this country to learn that tacking intolerance head-on is the pre-condition for changing history. If HIV-stigma is not tackled, AIDS will blight the 21st century just as racism affected the 20th century.

Thank you.