Panaji, July 14 (TNN): With the issue of HIV related stigma and discrimination being addressed in the state, I have attempted to put more light on the issue. There is need to understand the issue, not only in relation to the children who are facing discrimination, but close to 14,000 odd HIVpositive individuals found positive in Goa. Rivona case should help us to strategize for a long term impact.
Goa had set an example to the rest of country three decades ago and had created an impact in addressing HIV-related stigma and discrimination. India's first HIV litigation arose when HIVpositive activist Dominic D'Souza was incarcerated in the late 1980s. D'Souza, a resident of Goa, was found to be HIVpositive when he donated blood at a Goa hospital. The test was performed without his knowledge or consent, and the results were revealed not to him, but to the local police.
D'Souza was subsequently arrested and confined in an unused TB sanatorium pursuant to the Goa, Daman and Diu Public Health Act, 1985, an amendment to which in 1986 authorized the state to mandatorily test any person for HIV and isolate them if they tested HIVpositive.
He challenged the Goa Public Health Amendment Act, which called for mandatory isolation of an HIVpositive person. He won a partial victory when the court ruled detainment was mandatory only in a "justifiable" case. His legacy continues through Positive, the NGO he started to help people living with HIV.
Dominic's case highlighted several aspects of the laws that are related to the HIV epidemic beyond the application (or mis-application) of public health laws. Dominic was tested for HIV without his consent, his confidentiality was breached, and eventually, when he was released, he had lost his job.
Since that first case, violations of the rights of people living with or affected by HIV have increasingly come to light, many legal cases have been fought and won or lost, and many judgments have been pronounced by the courts.
It should be understood that those who stigmatize people living with HIV falsely believe that the virus is highly contagious and that they could easily become infected. When that happens, others start to view HIV-positive as a threat. Many become isolated - within their homes, in public, at their workplaces. They are further stigmatized by others' assumptions about their moral integrity - such as the belief that they became infected with HIV because they chose to take part in risky behaviors.
Also, stigma and discrimination continue to undermine prevention, treatment and care of people living with the HIV and AIDS. It hinders those with the virus from telling their partners about their status. It threatens their access to health care. It increases their vulnerability to physical violence. And HIV-related stigma affects people's ability to earn a living, making it even more difficult for them to lift themselves out of poverty.
HIV and AIDS have highlighted such vast inequities, violent abuse and widespread stigma, that human rights have been violated in a manner and on a scale rarely witnessed before in the public health sphere. The HIV epidemic cannot be looked upon as just a medical problem. It touches on the most personal behaviours and aspects of people's lives, and its effect is felt in every sphere of a person's life. Combating it therefore demands an approach that integrates social, cultural, economic and human rights perspectives.
While we discuss this, I wish to bring to fore more issues related to this. Once an adolescent finds out about his or her HIV status, disclosure, safer sex and family planning become pressing issues, requiring services tailored to the specific needs of adolescents. Despite the growing importance of this population group, they are largely left out of HIV/AIDS responses in the state. One effect is that existing paediatric and adult services are often ill-equipped to deal with their complex needs.
This emerging situation underscores the need to recognize these adolescents in Goa as well, learn more about their lives, identify their preventive information needs and service priorities, and design appropriate programs for their special needs. Civil society organizations and the state at large, need to have planned and sustainable programmes for children, rather address issues as they come to the fore.
While, I highlight the above, I also wish to bring to the attention of public at large, some of the instances of stigma and discrimination faced by people living with HIV in Goa. Discrimination in medical setting is widely prevalent. Surprisingly, even I came across staff of an NGO working in the premises of GMC to provide services, identifying HIV patients and alerting others to maintain distance. Some who are availing 50% bus concession from KTC also face discrimination by conductors who sometimes grill them on the card and also deny them concession. Most of the migrant PLHIVs, including children are denied social entitlement and social security schemes. People accessing DSS schemes are constantly under fear and sometimes refrain from accessing schemes due to fear of status being revealed.
The government besides providing some social entitlements should also focus on long term HIV impact mitigation. It's high time that all stakeholders working to address HIV in the state come together on a common platform and address HIV through need-based, planned and sustained programmes. It requires commitment, courage and leadership at all levels.