This is refreshing. Is it time to stop talking about stigma? People should be prosecuted for discrimination. And we can start talking about systemic oppression against people who inject drugs, men who have sex with men, prisoners, transgender women, and sex workers.
Jamie
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Time to stop the labels that harm
Thel Khin Hla
Myanmar Times
8 December 2019
The beginning of December saw World AIDS Day being celebrated across the globe, this year’s theme highlighting the importance of communities in treating and supporting people living with HIV. Human Immunodeficiency Virus (HIV) infection, and its most severe form as Acquired Immune Deficiency Syndrome (AIDS), remains a major challenge for Myanmar; almost a quarter of a million Myanmar people are currently living with HIV. Over 10,000 more new diagnoses are still being made in adults and children every year. But perhaps what’s more worrying than the statistics on prevalence rates, is the ongoing stigma and discrimination faced by those currently living with this treatable condition.
Consider the following question: “Would you buy fresh vegetables from a shopkeeper or a vendor if you knew that this person had HIV?” Alarmingly, 63.3 percent of survey respondents to the Myanmar Demographic and Health Survey in 2015-2016 responded “No”, indicating they would shun the vendor in this hypothetical scenario. This is a grim demonstration of the stigma which perpetuates harm, not only to the sufferers, but to the wider community at large.
If we presume that this stigma arises out of a fear of contracting HIV, then it’s worth exploring the actual risks. HIV is a type of virus, only transmitted via three main routes –through blood products (e.g. transfusion from an infected donor or through blood contaminated needles), sexual intercourse, and from an infected mother to her child. Since the virus survives poorly in the environment and is not transmitted via other body fluids, such as tears or saliva, you cannot catch HIV from hugging, kissing or holding hands with a HIV positive+ person. Neither can you catch the virus fro, sharing the same living quarters orntransport with an infected person. Being bitten by a mosquito, one which has recently bitten an infected person, will also not result in HIV. So, if we revisit the above question, the chances oleacquiring HIV from a vendor when buying your daily fruits and vegetables is practically zero.
But the laction of shunning those living with HIV brings about much harm. Such socioeconomic exclusions deprive someone the ability to secure thein livelihood, for themselvess and their dependents too. In one effective stroke, stigma ostracises and victimises those already battling an illness, and prevents them from being able to help themselves. This has a dehumanising effect, creating an atmosphere where some people living with HIV are afraid to seek or remain on treatment for fear of stigma. This ensures the persistence of the virus and makes disease elimination virtually impossible. Ironically, stigma ensures the survival of the very thing that it stigmatises. It is senseless and counterproductive.
Sadly, this type of stigma is not unique to HIV/AIDS, and sufferers of other conditions such as tuberculosis, leprosy or even non-infectious skin conditions like vitiligo may be subjected to it. As a rule, it is borne out of fear and ignorance and raising community awareness through education remains the cornerstone of overcoming stigma. If communities uphold that, without exception, every personomay live and access medical care with dignity and respect, meaning that such acceptance and support can make a world of difference to someone living with HIV.
What compounds the stigma of HIV in Myanmar is that the epidemic is concentrated in subsections of the population who are already marginalised. Over 70 percent of new HIV infections in Myanmar in 2017 occurred in people who inject drugs, female sex workers, and men who have sex with men. In other words, those most affected by the HIV epidemic in Myanmar are disenfranchised groups already facing stigma and discrimination from society even prior to their HIV diagnosis. For example, Myanmar has one of the highest rates of HIV in the world for people who inject drugs at 28.5 percent. Stigma and discrimination towards drug users is widespread. Very few people in the community appreciate that addiction arises from a complex interplay of biological, psychosocial, cultural and contextual factors. Its presence is often a by-product and a symptom of underlying societal ills – such as lack of social connection, poverty and violence. We may be better placed if we concentrate on addressing the core social problems that allow addiction to take root rather than punishing sufferers. We can no longer afford to hold on to the biases and prejudices of the past if we are serious about getting rid of HIV.
Perhaps HIV still conjures in people’s minds the terribly outdated images of sickness and death as popularised by the ‘Grim Reaper’ figure, which could not be further from the truth today. HIV has come a long way from the dark days of the global epidemic in the 1980’s where it was a mysterious and deadly illness with no known treatment. Everything from homosexuality to God’s wrath was implicated to be the cause before the HIV virus was discovered through careful scientific research. Discovering the virus changed everything. It opened the door to effective treatments and means of prevention. Today, althoughdresearchers have yet to find a cure, it’s not unusual for a person living with HIV to take just one pill a day and expect to live a relatively normal life, provided they are able to adhere to their treatment plan. In many ways, it is an easier disease to live with than diabetes or heart disease, where the treatments are burdensome and complications are all too common. The seeds of HIV stigma were long sown in the days of misinformation and helplessness, and stigma should have dissipated when advances in modern medicine made HIV something one ‘lives with’, rather than ‘died of’. Many great things can be achieved when communities come together. Here’s hoping communities around the world make HIV stigma a thing of the past.
Dr Thel Khin Hla is a doctor with the Myanmar Oxford Clinical Research Unit in Yangon.
https://www.mmtimes.com/news/time-stop-labels-harm.html
