Zero Discrimination Day, commemorated on March 1 every year, is particularly important for Cambodia. The HIV response here has made incredible progress. Four of every five people living with HIV are aware of their status. And once diagnosed, the vast majority start treatment and achieve viral suppression. As the country embarks on the last mile toward ending the AIDS epidemic, we must now work to improve the lives of people living with HIV and key populations and reach those still not accessing HIV services.
For both these challenges, our biggest barriers are stigma and discrimination. Intolerance and worry about experiencing injustice can make people fearful to learn their HIV status, make it difficult for them to access treatment and undermine their ability to stay the course.
After seeing an HIV positive colleague mistreated in the workplace, a man decides never to disclose his status.
A transgender woman refuses to return to the hospital for her antiretroviral treatment because a staff member spoke to her harshly.
A young gay migrant man knows he should get tested, but worries about how people will treat him.
Forty years into the HIV pandemic, stories like these are far too common. We have the tools to end this epidemic but are hampered by prejudice based on factors including HIV and key populations status, age, income level, ethnicity, sexual orientation, gender identity and migrant status. Bigotry and the fear of being treated differently are not only harming individual lives, but slowing collective gains.
The 2019Cambodia Stigma Index 2.0 study revealed that a majority of people living with HIV remain fearful to disclose their status to their employer, coworkers, friends and neighbours. The most common forms of discrimination people experience are verbal harassment and being excluded socially. These dynamics can be incredibly harmful. Among the respondents who delayed starting treatment, many were simply fearful about people finding out. This means that how we treat others has a direct impact on whether people feel empowered to access life-saving services.
The Cambodia healthcare system and its partners have taken steps to reduce stigma and discrimination, however, there is still some work to be done. Eleven per cent of men and eight per cent of women in the latest Stigma Index study reported that health facility staff disclosed their HIV status to others without their consent. And almost eight percent of respondents reported being spoken badly about or gossiped about because of their HIV status.
To eliminate stigma and discrimination in healthcare settings we must consistently implement policies for the prohibition of all forms of discrimination, while continuously investing in anti-stigma and discrimination training. In addition to the implementation of Patient Satisfaction Feedback among people living with HIV at HIV treatment facilities, UNAIDS also encourages the expansion of community-led monitoring. This is an accountability mechanism directed and implemented by community-led organisations of people living with HIV and key population networks. They work together with health care settings to improve HIV service quality and access. Such inclusive and collaborative approaches are key to ensuring nobody is left behind.
The government of Cambodia has already taken critical steps toward securing the rights of people living with HIV and contributing to the accomplishment of the sustainable development goal (SDG 10) on reducing inequalities. The 2002 Law on the Prevention and Control of HIV/AIDS bans mandatory HIV testing, requires test results to be kept confidential and prohibits discrimination against those living with the virus. Cambodia recently joined the “Global Partnership for action to eliminate all forms of HIV related stigma and discrimination” and prioritizes strategies to address HIV related stigma in community, healthcare and education settings. We must now take the next steps – raising awareness in the community, healthcare and other sectors and doing more to hold duty-bearers accountable.
Together we must do a better job at addressing the interpersonal dynamics that lead to new HIV infections, delayed diagnosis and poor adherence to HIV treatment. Let us use today, Zero Discrimination Day, as a springboard for action to challenge the harmful attitudes that fuel the HIV epidemic and take actions to End AIDS.
Patricia Ongpin is UNAIDS country director for Cambodia, Laos and Malaysia
The views expressed in this article are those of the author.