RESPECT AND STIGMA — DETAILS AND RECOMMENDATIONS

"What is at stake is human dignity. If a man is not accorded respect he cannot respect himself and if he does not respect himself, he cannot demand it." - Cesar Chavez

Prejudice and persecution of people with illness has a long history, going back to days when leprosy was believed to be a sign and outcome of immoral behavior.

Today, though we know that disease comes from germs and infection, many Americans feel that people with HIV/AIDS have somehow gotten what they deserved . When asked how they feel about people with HIV/AIDS, 1 in 6 Americans replied: "disgust."

The intensity and extent of these destructive feelings impede our nation's capacity to respond with reason to the HIV epidemic. Lack of public commitment to guaranteed access to HIV prevention, treatment care and support is only part of the picture. Discrimination against people living with HIV actually fuels the spread of the epidemic and increases its social and human costs.

HIV-related stigma and shame are powerful inhibitors against seeking out HIV testing or even accepting that they may be at risk. This is one of the reasons that a quarter million people living with HIV in the United States are unaware of their status . And compared to HIV-positive people who know their status, people living with undiagnosed HIV are 3.5 times more likely to transmit the virus — that's how stigma drives infection.

About a third of people who test positive for HIV are diagnosed with AIDS within a year , indicating a long period of untreated infection. Delayed diagnosis leads to more costly and complicated treatment and a heavier burden on public systems of healthcare and social service. People who are diagnosed late in the course of infection are more likely to require public assistance and much more likely to die of AIDS. That's how stigma deepens the costs of the epidemic.

HIV-related stigma is a difficult problem tangled up with biases of race, class, sexual orientation, and culture — it is not a problem with easy answers. But experience and research have shown that thoughtful policies consistently applied can lead to real improvements. Two such policies are highlighted here.

The president of the United States can deliver the vision and power needed to confront the noxious haze of stigma and bias against people living with HIV/AIDS. Our next president must be a leader in the fight against HIV stigma and for the respect and dignity of all people living with HIV/AIDS.

Recommendations on respect and stigma

• Ensure opportunities for work and self-support, medical privacy, conformance with the 1983 Denver Principles and full human rights for people living with HIV/AIDS;

• Ensure that services provided to PLWHAs are culturally competent, scientifically based and appropriate for the population they strive to serve;

• Ensure that policies affecting the lives of individuals living with HIV/AIDS in the US and globally take into account the cultural and social drivers that lead to healthy outcomes that also increase an individual's ability to function at a higher level of independence;

• Create program designs that take into account the HIV/AIDS stigma still heavily present throughout general society and within the HIV/AIDS field. Require that such programs work to provide those who access them with respect and consideration for the unique factors in their lives;

• Work to create educational programs for ALL medical and social support professionals about the truth and myths surrounding the lives of PLWHAs.