I am HIV positive. Few of my close friends know about my HIV status. At first I told it to my wife. After knowing my HIV status, her behavior towards me was very discriminatory. My wife suspects me. The day my wife came to know about my HIV status, she poured patrol all over the house. She wanted to die with our two little children that day. However, my utmost efforts prevent my wife from setting fire. My wife began to use separate bedroom, bathroom, soap and almost everything of our house. If our two children wanted to come to me, my wife would forbid them. In this way I passed two and a half years. In this period, I was totally separated from my wife and children.” said Sonjib (a pseudonym HIV-positive). In family level, many people become stigmatised and discriminated for their HIV positive status. PLWHAs (People living with HIV/AIDS) face discrimination, stigmatized behavior, social criticism and social rejection after disclosing their HIV status. In 1987 Jonathan Mann, the Director of World Health Organizations Global Program on AIDS, forecast three components to the HIV epidemic: the first would be HIV, the second AIDS, and the third would be Stigma, Discrimination and Denial. He predicted that stigma and discrimination and denial would be as central as the illness itself. UN Secretary Ban Ki Moon says: “Stigma remains the single most important barrier to public action. It is the main reason why too many people are afraid to see a doctor to determine whether they have the disease, or to seek treatment if so. It helps make AIDS the silent killer: because people fear social disgrace of speaking about it, or akin gasify available precautions.”
According to our societal view, people who are infected with HIV virus are considered to be caused by sexual intercourse which is not socially sanctioned in our conservative Bangladesh. It is also not approved by religious morality. This leads to one of the barriers to curb the disclosure of their HIV-positive status. As a collectivistic society like Bangladesh, HIV-positive individual may be seen as a reflection of not only oneself but also one's family or community. Therefore, PLWHAs want to keep the information secret to avoid social criticism. AIDS is a dangerous and shameful disease to them. If it is disclosed, it will be difficult for them to sustain the family and conjugal life.
Many people in our country are fearful that HIV is contagious and can be transmitted through casual link contact like holding hands and hugging. In our country, the information of HIV and AIDS sometimes misguides people. The silent surrounding of the disease and various myths, taboos and misconceptions about the disease also increase stigma among the PLWHAs. When family knows HIV status, this becomes a tale and that is why his or her respect decreases. Besides, many people hide their HIV status from their family members due to the fear of the decrease of respect. PLWHAs in our country do not disclose their status to their friends, neighbours or others, because they fear if all know their status, they will be more stigmatized and discriminated than the present. Most of the educational institutions do not allow HIV students to study at their institutions. PLWHAs suffered economically due to discrimination of losing their jobs. Stigma and discriminations are daily realities for people living with HIV. Many PLWHAs have even become the victim of the worst discrimination due to positive status.
Women tend to experience greater stigma and discrimination than men in our society. They have also fewer resources for acclimatizing with this situation. In our society, women are only eyed for their household activities and reproductive activity. Adolescent girls are forced into early marriage because of unequal access to education, empowerment and decision making rights. Women are forced to engage in unprotected sex due to their powerlessness in decision-making. In most of the cases, married women are infected with the virus by their husbands.
Self or internal stigma is another important fact that forces many of the PLWHAs to feel guilty and shame for their status. Self or internal stigma is an ongoing phenomenon that places a social burden and barrier on PLWHAs. PLWHAs feel isolated, guilty, dirty and full of shame. Many PLWHAs perceive AIDS as a moral punishment for them. They often believe to deserve their illness because they have done something “wrong”.
We are now frequently having meetings, round tables, debates that might teach us some lessons but we do not discuss about HIV/AIDS related stigma and discrimination. It is one of the major hidden reasons for why people are not interested to test HIV. In addition, this is why most possibly in near future HIV/AIDS will be the silent killer to aggravate the situation of Bangladesh. People of our country look this disease as a “curse of God” or as a “punishment for bad behavior”. People are afraid to come forward to be tested for HIV. The fear of stigma and discrimination makes them hide that they are HIV positive. HIV positive individuals, their relatives, friends, their most close ones and even the doctors are reluctant to give them proper care and support when they need the support most. They may be forced out from their homes, jobs, educational institutions and even from society. In the United States, HIV confidentiality guidelines recommend that health professionals should not divulge personal information to others in ways inconsistent with the client's original consent (United States Centers for Disease Control, 1999). But in our country we have no effective rules regarding this issue.
The risk behavior of HIV/AIDS is deteriorating in our neighboring countries like Myanmar, India, Nepal and Pakistan. Bangladesh is in a better position, but not out of danger. According to National AIDS Committee (2006) 7500 person are living with HIV nationwide. Journal of Health, Population and Nutrition estimates that HIV/AIDS remains at less than 1% amongst most at risk populations. The number of current positive population in Bangladesh is not significant at this moment but the important issue is that the numbers are steadily increasing. Female and male sex workers, IDUs (Injecting Drug Users), migrated workers, transgender persons are very risky population for the transmission of HIV/AIDS in Bangladesh. Bangladesh is in a vulnerable zone due to high transmission rate of HIV in our neighbouring country India. Indian efforts have failed to address the issue of stigma and discrimination and negative attitudes towards the PLWHAs in their policy. As a result, PLWHAs try to hide their status to everyone, even to their life partners due to social ostracisms.
Various measures, plans, programs and policies have been taken by both government and non-government organizations to reduce the outbreak of HIV/AIDS throughout the world. Various policies have been successfully implemented but the matters of stigma and discrimination of HIV/AIDS patients have not come on focus or upwards with the importance in the discussion or have not yet been included in the policy. So it is high time to rectify our behavior towards the PLWHAs. If we will be able to reduce the fear of stigma and discrimination of HIV/AIDS patients, patients will come to test for HIV and it will be possible for us to resist the outbreak of this fatal disease. We should increase the religious morality and teachings which will be a safeguard for the involvement of highly risky behavior. We should not maltreat the PLWHAs. They have the right to get good behavior from the mass people. They have the right to get medical treatment and the right to get personal support and care from their family and friends. State should not violate their human rights. We should not maltreat them in a way that they are forced to accept death before their inevitable death. We should increase positive attitudes among the people towards HIV/AIDS patients and reduce the prejudices against this disease.
The writer is Lecturer, Department of Social Relations, East West University .