Stigma and discrimination can be deadly: Lessons from HIV for the coronavirus response

By Mandeep Dhaliwal, Director of HIV, Health and Development, UNDP; Ludo Bok, Manager, SDGs and UNAIDS, HIV, Health & Development Group UNDP

As new coronavirus cases are confirmed each day, fear and misinformation continue to spread more rapidly than COVID-19 itself. False or misleading claims in the media, buoyed by harmful stereotypes, have fueled discrimination and violence that revive painful histories of attributing disease outbreaks to marginalized groups. Health officials have taken note of the disturbing trend, cautioning that stigma and discrimination could undermine efforts to contain the outbreak.

This is not the first time stigma and discrimination have stymied a response to a growing epidemic and hampered progress toward critical global health goals, including universal health coverage. When HIV first came to the fore in the 1980s, lack of access to timely, accurate information fueled widespread stigma and discrimination against those most affected. Even when testing, treatment and prevention measures became available, people did not access services out of fear that they would be exposed to further stigmatization, discrimination, violence or arrest.

Decades later, stigma continues to have devastating effects on people living with HIV around the world — especially for groups already facing systemic discrimination, like women and girls. For too many women and girls living with HIV, the fear of violence and stigma can be a barrier to accessing health services and prevent them from seeking support from their families and communities. Health for all cannot be achieved unless all people — especially marginalized groups — can access health services without fear of harm.

In an effort to combat HIV-related stigma and discrimination, some countries have used their court systems to uphold the rights of women living with HIV. Namibia’s Supreme Court ruled that the practice of forcibly sterilizing HIV-positive women was a violation of their rights, allowing women who had been subjected to the procedure to seek redress for physical and psychological damages.

In Malawi, a woman was convicted under a misguided law that made it illegal for women with HIV to breastfeed, despite evidence that women who are on antiretroviral treatment have an infinitesimal chance of transmitting the disease to their child. The Malawi High Court overturned the conviction, demonstrating the importance of grounding judicial decisions in scientific evidence and protecting vulnerable groups from “the unjust consequences of public panic.”

Other countries are enacting policies to tackle stigma and make it easier for vulnerable populations to access the health services they need. Last year, Tanzania lowered the age of consent for HIV testing from 18 to 15, encouraging adolescents to get tested and helping to normalize HIV testing within an age group that’s at high-risk for transmission. Colombia and Belarus also struck down laws that criminalized the transmission of HIV, making it easier for people to seek health services without fear of persecution.

To ensure countries are prepared to respond to outbreaks like COVID-19, we must implement lessons learned about the importance of investing in programmes to eliminate HIV-related stigma and discrimination. Governments, media and civil society must put forth accurate, timely information about how people can protect themselves and others from the virus, and take steps to combat false, discriminatory narratives, which are ultimately counter-productive. Alongside preparedness measures, countries must ensure efforts to strengthen health systems and promote universal health coverage are truly inclusive by prioritizing and protecting vulnerable groups, including by implementing rights-based laws, policies and procedures.

A few weeks ago at the 2020 Munich Security Conference, WHO Director General Dr. Tedros ended his remarks with a question: “We have a choice. Can we come together to face a common and dangerous enemy? Or will we allow fear, suspicion and irrationality to distract and divide us?” To combat stigma and discrimination and achieve universal health coverage, we must not divide ourselves further. Ultimately viruses don’t discriminate on the basis of race, religion, gender identity or sexual orientation. On this Zero-Discrimination Day, let us learn the lessons from HIV and reinvigorate our commitment to respecting human dignity and equality.