Dr. Avnish Jolly:Challenging stigma associated with HIV/AIDS and integrating HIV/AIDS programmes with other sustainable development programmes are critical for an effective response.HIV pandemic affects urban / rural men, women and Children differently. While policies are focused at urban men’s needs, they are not looking at rural people, women’s and children’s realities to the extent they should. They are dependent and, therefore, more vulnerable whether it is negotiating condom use or having sex for money and coming forward for care and support.
Men, women and children experience stigma differently; women and children experience its consequences more severely because they are economically, socially and emotionally dependent. In some cases the stigma of HIV/AIDS is adding to the layers of stigma people are already facing: as sex workers, injecting drug users, men who have sex with men. I grew up in India and understand the Indian context, which is very valuable in the nature of my efforts.
It is important that economic empowerment, rehabilitation programmes go together with HIV treatment and care programmes in the focus of social and emotional support.
The same goes for programmes around their education and anti-violence. We know there is a direct co-relation between education, violence against them and their vulnerability to HIV. The point is, you cannot just advocate: use a condom – its availability on papers (it’s very difficult to obtain Condom at night at many places and it’s not 100% safe), practice abstinence and faithful to partner is equally important to prevent HIV infection.
We understand their risk and the need to mainstream HIV prevention and care with other development programmes. This is initiated at different levels in the smaller communities in different parts of the community, although much more needs to be done at the level of Local, National and Global Policy.
There needs to be a wider recognition of this networking. Since research shows that their vulnerability to HIV is not a bio-medical domain but a social, cultural and developmental issue, perhaps this collaboration requires community-based self sustainable and initiated programmes in different interventions according to local needs and global context.
One can initiate helping them to organised where they see themselves not as isolated but as part of a larger society; we give them orientation and provide them tools for decision making for sustainable development, make services for HIV prevention such as treatment of sexually transmitted diseases and testing for HIV available to them with their help only. We can protect them from violence from People, Pimps and Police and offer alternate livelihood to those who want to live self sustainable life.
Stigma and discrimination is a key problem in response to HIV. Ignorance and lack of correct knowledge are the most important factors increasing stigma. Most of researches show that it is important to provide clear, correct and complete information to ensure people are not afraid of being infected through casual contact. They need to know how HIV is transmitted, how the virus dies very quickly when exposed to air. People are less likely to stigmatize when they know they need not be afraid of HIV transmission through casual contact. The other aspect influencing stigma is the perception that HIV positive people have somehow stepped out of the ‘moral’ boundaries. That has changed — it is false — we know that anyone can get infected.
The legislation against HIV discrimination and its implementation will, I am sure, go a long way in reducing stigma and violence. The more you stigmatize, the more infected people go underground and that is likely to fuel spread of HIV. Therefore, rolling out treatment will help. Presently, HIV is associated with blame, shame, morality. If we have any illness we are not ashamed of it, why should we be ashamed of HIV?