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Striving for zero discrimination in health care

Dr Gottfried Hirnschall, WHO, Director HIV

1 March 2016

The United Nations designated 1 March “Zero Discrimination Day” after UNAIDS launched its Zero Discrimination Campaign on World AIDS Day, 2013.

Today, we focus on zero discrimination in health care settings. HIV-related stigma and discrimination is not new. But like the response to HIV, it is continuously evolving.

Dr Gottfried Hirnschall, Director, Department of HIV/AIDS.

Effective treatment means that people living with HIV can live long, healthy and productive lives and present little or no risk to transmitting HIV to their partners. This shift, especially when compared to the earliest days of HIV, has helped positively to address some aspects of stigma and discrimination. Yet, in too many instances, the fear of stigma can still outweigh the fear of HIV itself. As a consequence many people may avoid being tested, thereby depriving themselves of access to HIV treatment and other critical services.

Juliana Odindo, an inspiring HIV-positive young Kenyan woman, has seen many people close to her die as a result of their reluctance to access testing and treatment services because of stigma and discrimination. Juliana is active in calling for the health sector to strengthen its efforts around HIV – to play its role in providing health care that is decent, respectful, and free of prejudice and stigma. Her drive and energy is motivated by personal loss and a strong sense of injustice.

Juliana knows from first-hand experience that although treatment is widely available and can ensure long life for people living with HIV, more than 1 million people still die unnecessarily every year.

Stigma and discrimination

Stigma and discrimination within healthcare settings continues in different forms. It can include the refusal of services, inferior quality of care and a lack of respect. People living with HIV still encounter abuse and mistreatment, the denial of consent in healthcare decisions - even compulsory detention.

Discrimination can be directed towards people perceived to be at risk of HIV as well as towards people living with HIV. Groups already marginalized by society, for example, sex workers, people who use drugs, men who have sex with men, and transgender people often experience strong discrimination in health settings – whatever services they are seeking. And this happens, even though we know that HIV infections are disproportionately higher in these key populations.

While many of the healthcare workers I know are among the most inspiring advocates for providing decent and stigma-free care there are also others that still do not.

One important issue here is a move away from specialised HIV services to a model of decentralized, integrated health services. In many ways this is welcome. It roots HIV services firmly in regular healthcare – delivering cost savings and a more localized, people-centred approach.

But it also means that our health workers need to be properly trained and empowered so that they can provide decent care. We need to ensure that frontline health workers have the information and skills required to effectively identify, address and avoid stigma and discrimination of all types, including those related to HIV. Health workers need protection themselves too. Many of them also living with HIV might be exposed to discrimination themselves. Health workers should have access to HIV prevention commodities such as condoms, post-exposure prophylaxis if accidentally exposed to HIV, confidential testing and treatment and care.

Tools and initiatives

Fortunately we have a number of tools and initiatives that we can build on to address stigma and discrimination. Last September governments agreed to adopt Goal 16 of the Agenda for Sustainable Development, which calls for inclusive societies that promote non-discrimination.

In May this year, the World Health Assembly will consider the global health sector strategy on HIV for 2016-2021. The strategy strives to ensure zero HIV-related discrimination in all settings, especially health settings, and includes a target to ensure that 90% of people living with HIV and key populations report no discrimination in the health sector.

As part of the strategy, WHO develops and promotes policies and guidance that explicitly address gender inequality, gender-based violence, stigmatization and discrimination, health needs of key populations, and public health alternatives to criminalization

WHO, together with the Global Health Workforce Alliance, UNAIDS and other partners seeks to ensure health workers are effectively trained to deliver people-centred care. Collectively we seek to end policies and practices that reinforce stigmatization and discrimination in health care settings and create environments where people access HIV services without fear. The Global Strategy on Human Resources for Health: Workforce 2030 is a critical additional tool in this fight.

Zero Discrimination Day calls for transformative action. Advocates like Juliana continue to help us visualise a world where transformative action is possible. We must take time to listen to and engage with inspiring leaders like Juliana and communities most affected by HIV. For all of us working in the health sector ensuring health services are safe spaces that are free of stigma and discrimination for all people living with or affected by HIV is not just an option – it is our collective responsibility.