HIV Stigma in Health Care Settings: A Need for Greater Partnership of Doctors and Lawyers in Ending AIDS

Health and Human Rights Journal
Theresa Cheng
Original Article: 

The global health community has been debating when we will reach the end of the HIV/AIDS epidemic. 1 As of 2012, 96% of governments had stepped up to the challenges of managing the epidemic within their own borders by redoubling country investments and integrating HIV planning with national health agendas.2 However, it is increasingly apparent that ending AIDS cannot be achieved without national plans that address gender inequalities and the disproportionate discrimination against HIV-positive women, including within health care settings. As an M.D./J.D. student studying the care of HIV-positive women and the diverse legal systems supporting their human rights, I see the global HIV response as lacking vital partnerships between medical and legal communities.

Globally, even though women living with HIV (WLHIV) are more likely to be in care, compared with other at-risk populations, the health care they receive is frequently neither comprehensive nor stigma-free.3 Emerging evidence reveals that WLHIV are still likely to experience discrimination in the form of pressure from their health providers to have abortions and be sterilized. For example, in 2011, a study in six countries in Southeast Asia found that 30% of 757 HIV-positive women were asked to undergo sterilization, and the majority (60%) had been asked to do so by an obstetrician-gynecologist and/or an HIV clinician.4 In Pakistan, 37% of 228 WLHIV said that health care professionals had coerced them into terminating a pregnancy.5 Without free and informed consent, these abortions and/or sterilizations are human rights violations. They also create barriers to access to critical preventative and reproductive health services. Discrimination in health care settings limits the implementation and effectiveness of national HIV plans and global efforts to eliminate mother-to-child transmissions, ultimately constraining progress towards an end to AIDS. 6

Foremost among the global response to reports of HIV stigma has been a UN interagency statement condemning forced, coerced, and otherwise involuntary sterilizations of all women.7 While significant, this declaration and other initiatives reveal a disconnect between the experts in health and HIV care (doctors) and the experts in international human rights law (lawyers). Despite the growing recognition that human rights and gender equality must be central components of any HIV campaigns, these principles remain absent in many medical training programs and health care delivery scenarios, seemingly considered impractical or unnecessary. Policymakers—often lawyers—see laws are necessary to objectively delineate what is just and to ensure this justice is upheld. For medical providers, such laws can also represent unwelcome or unreasonable government intrusions into the patient-physician relationship.8

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