A study carried out by UNAIDS in July shows that in countries like Rwanda, the percentage of people holding discriminatory attitudes toward individuals living with HIV has significantly decreased, now hovering around or below 10%.
Simeon Tuyishime, Director of the HIV/AIDS Care and Treatment Unit at the Rwanda Biomedical Centre (RBC), attributes this decline in HIV-related stigma to several key factors.
"Through psychosocial support and counseling provided during each clinic visit, along with mental health screenings every six months, healthcare providers can identify individuals experiencing self-stigma or facing external discrimination. This enables them to offer enhanced counseling and support where needed,” Tuyishime explained.
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Tuyishime also underscored the critical role of community leaders, including teachers, district directors of education, and religious leaders, in dispelling myths and misconceptions about HIV.
"We collaborate with community leaders, such as teachers, district education directors, and religious leaders, to address myths and misconceptions. These leaders then educate their communities, enhancing their understanding of HIV,” he said.
Tuyishime highlighted the importance of early disclosure and counseling for children living with HIV (CLHIV). "The process of disclosure and counseling for children living with HIV begins early, ensuring they grow up informed about HIV/AIDS, which helps reduce stigma,” he noted.
He added, "Support groups are tailored to the specific needs and characteristics of people living with HIV, including children, adolescents, key populations, single mothers, and others. These groups provide a safe space where PLHIV can speak openly without fear of judgment and learn from one another.”
Patient confidentiality
Patient confidentiality is another crucial element in reducing stigma, Tuyishime emphasized.
"People living with HIV must consent to any information being shared. We ensure the confidentiality of patient information by keeping records and tools used in HIV services in a secure, private space,” he said.
Healthcare providers working in HIV services are trained and accredited with a strong focus on maintaining patient confidentiality and privacy. "We ensure that every health center and hospital has a private room for confidential HIV counseling and testing,” he added.
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Tuyishime also stressed the importance of regular community training to inform people living with HIV about their rights, including the right to confidentiality.
Impact of Stigma on Health Outcomes
HIV-related stigma has significant impacts on patient health outcomes, particularly regarding treatment adherence and mental health.
"Stigma has led to treatment interruptions, especially among adolescents and young adults, resulting in increased viral loads and poor adherence. It also causes delays in seeking treatment, contributing to issues like depression and anxiety, and creates fear about disclosing HIV status to those who could support adherence and daily living,” Tuyishime explained.
However, as the population gains accurate information about HIV and understands that people living with HIV can take medication and lead fulfilling lives, stigma has decreased.
"This reduction in stigma has led to a rise in the number of people getting tested, with testing numbers steadily increasing over the years,” Tuyishime noted.
Challenges
Despite the progress, challenges persist. "Adolescents living with HIV in boarding schools often struggle with storing their medication due to persistent stigma and discrimination, leading to treatment interruptions,” Tuyishime highlighted.
He further pointed out that internalized stigma remains an issue among some individuals, and a limited knowledge of laws and policies that protect them means they often do not report experiences of stigma.
"Additionally, not all community members have been trained to dispel myths and misconceptions. There is also a gap in counseling knowledge among healthcare providers and peer educators, which may impact the effectiveness of counseling for those facing stigma,” he concluded.