Agenda item 8. Follow-up to the thematic segment from the 41st PCB
Delivered by Devanand Milton, Latin America and the Caribbean
Good Day All.
My humble appeal to you today: Let all of us work diligently to accelerate efforts to develop synergies and links between national, regional and global efforts in reducing stigma and discrimination in all forms, including in health care settings and to leave no one behind in the efforts to ending AIDS as a public health threat by 2030.
These cannot be done if stigma and discrimination towards key populations remain in health care settings. Stigma and discrimination against transgender people living with HIV creates challenges that result in many who are unable to access health care not only in the Caribbean, but the world over.
Presently, there is little or no data on Trans persons, which leaves us invisible and worse yet, nonexistent. In Guyana where I come from, the incidence rate for Trans persons is 8.4% and new HIV infections remain high among Trans people aged 15-24 years old.
My transsisters and myself have experienced first hand discrimination in clinics. On many occasions, doctors avoid touching us during examination and if they have to, they put double gloves in front of us and not for others. In 13 months, we had three deaths, since people did not want to go for treatment.
The attitude, skills and experience of health care staff matter in the success and/or failure of the AIDS response. Health-care settings, in particular, should be safe spaces, an “oasis from stigma and discrimination.” Health care providers need to model desired behaviour. Unfortunately, stigma and discrimination are still realities that manifest themselves in a variety of ways, such as refusing to admit patients, delaying or withholding treatment or other forms of care, not attending to patients in beds, breaching confidentiality, and making inappropriate comments.
One type of stigma is bad enough. But “layered stigma”— in which one stigma (such as stigma because of HIV infection) is “layered” on pre-existing stigma such as gender, poverty, and sexuality or sexual orientation—is even worse. Layered stigma promotes concentrated HIV epidemics.
UNAIDS has made zero discrimination one of the pillars of its strategy: AND I QUOTE
“The future of the HIV epidemic will depend on how well the Caribbean will address identified challenges. Leadership is needed to remove punitive laws that diminish stigma and discrimination. Laws that perpetuate stigma and discrimination and limit access to health care and fuel the spread of HIV are not in the national interest” (UNAIDS).
Greater political and policy commitment are needed to make health-related services “stigma free.”
What would stigma-free health services look like? That all personnel (“from the receptionist to the guard to the surgeon”) are trained, have existing guidance for stigma- and discrimination-free services, ensure that client satisfaction is monitored, and key populations are included among staff and in evaluating services.
I am requesting all Members States and key donors to increase their investments to adequately address discrimination in health-care settings as part of a fully-funded global HIV response.