World AIDS Day offers an occasion for communities and decision makers to examine progress made in countering the worst health crisis in modern history. The assessment is grim indeed: two decades into the crisis, despite medical advances in treating people with HIV and some national successes in slowing the spread of the disease, “the global AIDS epidemic shows no sign of abating,” UNAIDS and the World Health Organization reported last week. [download report from UNAIDS and WHO: AIDS Epidemic Update 2003 ]

Among the main reasons, in addition to the shameful shortage of resources to fight HIV/AIDS, is the persistence of stigma and discrimination against those infected. This outrageous violation of basic human rights drives the disease underground, crippling efforts for prevention, treatment and care.

Once again this year, some 5 million people were infected with HIV—14,000 every day; 95 per cent of them live in low- and middle-income countries, 60 per cent in sub-Saharan Africa. Half of them are between ages 15 and 24. Forty million people are living with HIV/AIDS; 3 million died this year—the most ever.

In this context, the myths, stereotypes and judgments surrounding HIV/AIDS and its transmission are as deadly as the virus itself. Stigma and discrimination:

• Keep sufferers out of sight, allowing governments to deny the severity of the crisis and play down the need to scale up prevention and treatment efforts.
• Keep people from seeking to learn their HIV status and receive counselling-essential aspects of prevention-out of fear that they will be ostracized, rejected and even harmed by their communities and families.
• Prevent those living with HIV from accessing care and treatment, where available, helping spread the epidemic further.

One of the most deadly myths, stereotypes and judgments is the association of condom use with promiscuity and irresponsible behaviour, which leads many people to forgo essential protection against sexual transmission. It prevents girls and women from negotiating condom use with their partners, including husbands who may be infected.

Overcoming HIV/AIDS-related stigma and discrimination calls for concerted advocacy efforts as well as legal support. Laws protecting the rights of people living with HIV/AIDS are an essential part of an effective response to the epidemic. And discrimination based on real or perceived HIV status is recognized as a violation of international human rights law. Yet 40 per cent of countries, including half the countries in sub-Saharan Africa, still have not adopted anti-discrimination laws.

Combating stigma and discrimination is a critical part of the fight against AIDS, and must go hand in hand with other prevention, treatment and care efforts, particularly action to combat the gender bias and violence that fuels the epidemic, and to ensure the widest possible access—including access for young people—to prevention education, information and services.