Thursday, March 06, 2008

Bangladesh: Stronger HIV policy needed

By, Reuters, February 19, 2008

Insufficient data, coupled with the lack of a coherent HIV prevention policy, are undermining Bangladesh's national AIDS programme, say health experts.

"We need to gather stronger empirical data and relate all problems faced by HIV/AIDS, with a special emphasis on the use of condoms by all who need them," said Dan Odallo, country coordinator of UNAIDS in Bangladesh.

Among intravenous drug users (IDUs), HIV has already become a concentrated epidemic - when five percent or more members of any high-risk group are infected.

"In more than one IDU cluster in Dhaka [the capital], 7.5 percent HIV-positive cases have been diagnosed recently," said Dr Mohammad Hanifuddin, director of the government's project to combat sexually transmitted infections (STI) and HIV.

Most of Bangladesh's more than 150 million inhabitants are largely unaware of the risk factors; moreover, many seldom practice safe sex, including condom usage, warned Prof Nazrul Islam, head of the department of virology at the Sheikh Mujib Medical University in Dhaka.

Poor official statistics

Although there are only 1,207 officially confirmed HIV-positive cases, national estimates put the number of people living with HIV in the world's eighth most populated nation closer to 7,500 but the real number could be several times higher.

"Most of these people do not go to the laboratories for a test," said Shahnaz Begum of Durjoy Mohila Shongho, a national NGO working with street-based commercial sex workers, citing the social stigma associated with the disease. "They only go to the labs when they are either compelled or enticed to. The official statistics are just the tip of an iceberg."

Islam noted that "The biggest problem facing the country's HIV/AIDS prevention and control programme is scanty statistics," and no one really knew what the true facts were.

Inept national AIDS programme


Wednesday, March 05, 2008

HIV women face up to stigma with campaign

By, The New Zealand Harald, February 21, 2008

A campaign to "de-stigmatise" women with the human immunodeficiency virus (HIV) was launched in Auckland yesterday.

The campaign is using five women with HIV to put a public face on the disease, in a bid to overcome ignorance and complacency.

Positive Woman, an HIV and Aids support group based in Auckland, said that in the past five years there had been a steady increase in the number of people, particularly women, with HIV.

National co-ordinator, Jane Bruning, said the campaign wanted all New Zealandersto question their assumptions about thoseliving with HIV.

She said many people believed HIV would not touch them and the risk was confined to specific sectors of the community.

"We are saying the risk is a lot closer to home, our faces and our stories are not so different to many New Zealand women."

She said because of the stigma of living with HIV, many women kept their HIV status secret, fearing negative reaction and discrimination. "The truth is that those living with HIV in New Zealand are everyday people leading everyday lives.

"No matter how a person contracts HIV, they shouldn't have to deal with the added burden of stigmatisation on top of chronic health problems."

The campaign will feature advertising on buses, a website and in magazines.



Tuesday, March 04, 2008

HIV stigmatization still widespread

By, Kate Melville, Science a gogo, February 26, 2008

Stereotypes and misinformation about HIV that are commonplace among the general public are also evident in a surprising number of clinical staff, a study from the University at Buffalo has found. Published in the journal AIDS Patient Care and STDs, Lance S. Rintamaki's study shows that more than 25 years after its discovery, HIV still has the power to generate a broad array of stigmatizing behavior. People infected with HIV have previously labeled dealing with stigma as the most significant social and psychological challenge of the HIV experience and Rintamaki's study shows little has changed.

Sufferers' experiences were categorized by the type of stigmatizing behavior that they experienced most often in the presence of health-care personnel. These categories were: lack of eye contact; assuming physical distance; using disdainful voice tone or inflection; asking confrontational questions; showing irritation, anger, nervousness, fear or panic; taking excessive precautions; scaring, mocking, blaming or ignoring patients; providing substandard care or denying care, and being generally abusive.

Stigmatizing experiences included judgmental behavior and panic on the part of providers when informed of a patient's HIV status, doctors "hermetically sealing" themselves before approaching the patient and patients being told they were going to die. Participants described being blamed openly by health-care providers for their condition. One patient told of being scolded by a phlebotomist; "If you hadn't done this to yourself, we wouldn't have to be going through this!" when he objected to being "poked" painfully several times as she searched for a viable vein to draw blood.

Other reports included the hospital worker who refused to mop the floor in an HIV patient's hospital room, the dentist who turned away a patient because of his HIV status and rough-handling by paramedics. One participant said he had so little eye contact with his neurologist that he couldn't describe the doctor's face. Another participant recounted a nurse's disdain when she delivered his AIDS diagnosis: "It was just so callous and cold the way she said it; 'You have AIDS.' There was no feeling. It's almost like a stone-faced warden or something. No concern."

"Given patients' sensitivity to any indication of bias or discrimination, it's likely that even well-intentioned health-care personnel sometimes engage in behaviors that are interpreted negatively by their patients," said Rintamaki. "The findings from this study give health-care personnel additional insights on what to avoid, or if certain protocols are standard procedure, what to explain further. These approaches might help to prevent misunderstandings."


China admits that cases of HIV/Aids have risen 45 per cent

By, Clifford Coonan, The Independent, February 23, 2008

New cases of HIV/Aids in China soared by 45 per cent last year compared with 2006, the Health Ministry in Beijing has revealed. The staggering rise was put down to changing social attitudes and an improvement in data collection.

The government had said late last year that 700,000 people were living with the virus, an increase from an earlier estimate of 650,000. The year before, China lowered its estimate to 650,000 from 840,000, despite warnings from international experts that the disease was spreading due to ignorance and because many people were too afraid or too poor to seek help.

The ministry gave few details about the large percentage rise in sexually transmitted diseases or those passed through the blood. There was also a sharp rise of 24 per cent in syphilis cases.

"It's been hard over the years to discover the number of Aids patients because of the social stigma," a ministry spokesman said. The disease is spreading fast in a country where information about Aids has long been suppressed. For many years, Chinese would say HIV/Aids was a disease that affected foreigners, and could be passed through shaking hands or sharing chopsticks.

The government has finally acknowledged that it faces a battle in resolving the rise in HIV/Aids infections. The disease is now mainly sexually transmitted; before, it had been mostly caused by intravenous drug use.

The United Nations has warned that China could have 10 million cases of HIV by 2010 unless it takes steps to educate the public and fight the epidemic.

A major advance in breaking down the stigma attached to HIV/Aids came in 2003 when Premier Wen Jiabao became China's first senior leader to publicly shake hands with Aids patients, marking a significant change in government policy on the disease. President Hu Jintao has also been photographed embracing Aids patients.

As well as the traditional routes of spreading HIV/Aids, such as prostitution and intravenous drug use, the disease in China has been spread by unsanitary, uncontrolled blood banks that travelled rural areas buying blood. About 70,000 people had been infected by contaminated transfusions.

The Health Ministry survey also showed that even among better-educated city dwellers, nearly 60 per cent were "nervous" to have public contact with HIV-positive people.

Against this kind of background, changing attitudes is an uphill battle, and the Health Ministry has come up with imaginative ways to deal with the problem. It has introduced a major TV campaign to promote condom use, with advertisements produced by the Oscar-winning Aids documentary maker, Ruby Yang. This is a significant advance in a country where talking about sex remains taboo.

China's 200 million migrant workers are among the high-risk groups. Building workers can now attend lectures on the ways HIV/Aids is spread and the importance of condom use.

"I came to know that Aids was not a disease exclusively belonging to sexually active Westerners," Chen Wei, 28, told the People's Daily after a session in the training school on a building site in Changsha in Hunan province.

In 2006, the government issued new rules. Now no organisation or individual is allowed to discriminate against Aids patients or their families, and Aids patients will be entitled to free treatment.

The Health Ministry data also showed scarlet fever and measles cases rose in 2007, though other diseases declined. There was just one death from plague last year, and none from cholera.


Monday, March 03, 2008

Breaking Down Barriers: A Woman's Path to Reducing HIV Stigma in the Arab American Community

By, The Earth Times, February 20, 2008

HIV/AIDS is still a taboo topic among many Arab Americans, but one determined woman is working hard to change this. For Dinah Ayna, talking about HIV and addressing the stigma among the women in her community is a challenging, yet a rewarding part of her daily routine.

According to the Arab American Institute, there are 3.5 million Arab Americans in the U.S. One-third live in Michigan, with most located in Dearborn, Michigan. As the Substance Abuse Prevention Coordinator at the Arab Community Center for Economic and Social Services (ACCESS) in Dearborn, Dinah does what no one else dares to do in the Arab American Community: talk to women about HIV and Sexually Transmitted Infections (STIs).

Dinah works at ACCESS' Community Health and Research Center that promotes physical, mental, and social health of the Arab American community using a holistic, multicultural approach. At the Center, Arab Americans, Arab immigrants, and refugees from 22 countries receive state-of-the-art services that range from physicals and immunizations to education about cancer, diabetes, and HIV/AIDS.

"We need to talk about HIV in a way that doesn't conflict with people's religious beliefs and culture," says Dinah. She finds that women in her community relate to her and the cultural context in which she frames the issues. As an Arab American woman - her parents are from Palestine - her work fills a cultural gap for appropriate methods that can help Arab American women discuss HIV.

In the Arab American community, sharaf or honor is an important social aspect within families where an individual's actions can bring shame to the entire family. Many women live in fear of painful repercussions within their families and communities, and would rather live in ignorance than know they have HIV.

Dinah spends most of her day talking to Arab American women, ages 16 to 50 that come to the Center for counseling and/or medical tests. She talks with them about safe sex practices, HIV, and STI testing options. "The biggest challenges," says Dinah, "are getting women to talk about HIV and getting them tested. Many women don't want to get tested - at least not before they come back to the clinic a few times."

In 2005, women represented 26% of new AIDS diagnoses, compared to only 11% of new AIDS cases reported in 1990. Due to the increase of HIV/AIDS in women and girls, the Federal government instituted "National Women and Girls HIV/AIDS Awareness Day," held each year on March 10. Its efforts align with ACCESS': encouraging discussions among women about HIV prevention, testing, and care.

Since many of Dinah's clients are mothers she emphasizes to them the importance of talking with their children about HIV. "There are few things as powerful as the mother to child bond," says Dinah, "Mothers can play a critical role in educating their children about health risks and safe practices."

ACCESS' Public Health Team incorporates discussions about HIV into most medical screenings. The Centers for Disease Control and Prevention (CDC) recommends voluntary HIV testing during routine medical and prenatal visits for all people ages 13 to 64. Dinah is passionate about making this a reality for Arab Americans.

Dinah is a trusted resource in the community. As one of her clients stated, "Dinah really put me on the right track." Much of her success stems from helping women realize that knowing their HIV status and educating their children about HIV, is first and foremost a matter of health.

To learn more about:

Arab Community Center for Economic and Social Services


Fighting Aids: Raped, pregnant, infected with HIV – and happy to help

By, The Independent, March 2, 2008

What could be worse than being raped? To be raped and to find yourself pregnant by your rapist. Or to be raped, pregnant and discover you've got HIV. And for the unborn child to be at risk of contracting HIV.

Three months after being raped by her boss, unemployed and sick, 21-year-old Mathakane Metsing was in her local clinic in Mafeteng, Lesotho. There she underwent two tests.

"Two blue lines and you're pregnant", the nurse told her. "And two red lines here and you're HIV positive." Four lines – two red, two blue. In 10 minutes. Mathakane cried for two days. Worse still, she discovered that she had passed the virus on to the man she loved and wanted to marry. And later, that her family was also infected; her two sisters and her mother, who died the following year.

Two years on, and I'm sitting with Mathakane for the launch of Unicef UK's Mother's Day campaign to prevent all mother-to-child transmission of HIV by 2010. She's minute and looks like a teenager. Wearing the traditional dress of Lesotho, and carrying a photo of her two-year-old daughter, she's one of the happiest people I have ever met. She speaks fluent English despite never having been taught and is now an Aids prevention campaigner and counsellor in Lesotho.

It's a constant struggle. Despite Mathakane's experience, she failed to convince even her mother to get treatment. "At first when they found out I had HIV, my mother and my sisters laughed at me. They didn't like me because of it. Then my mother found out she had HIV and she was very ashamed." Her mother died. Her brother died. Her sister-in-law died. Mathakane's friends still have unprotected sex. There is ignorance, stigma and superstition. Rape is widespread, she tells me. Virgins – usually prepubescent children – are raped by men hoping to cure themselves of the virus. Some men even think condoms carry the Aids virus.

In Lesotho, most of the men work in the mines in neighbouring South Africa. They visit brothels packed with HIV-positive prostitutes, get infected, then pass the virus on to their wives. Their wives get pregnant. Their babies get HIV.

At the summit in 2007, the UK government, along with all G8 countries, promised to contribute substantially towards the drugs to prevent mother-to-child transmission. At the moment only one in five pregnant women has access to those drugs. The estimated cost is huge – $1.5bn (£750m) – but so is the problem. Every minute a child is born with HIV and another dies because of it.

Mathakane's triumph is that, thanks to a £1 dose of the antiretroviral Nevirapine, her baby is HIV negative. Her name is Blessing.

Jemima Khan is a Unicef ambassador


HIV patients still face stigma from health care providers

By, Lois Baker, UB Reporter, February 28, 2008

The doctor who wouldn’t come into the patient’s hospital room. The neurologist who avoided eye contact. The ambulance attendant who angrily threw her bloodied gloves into the street after learning the injured patient was HIV-positive.

These are reactions of some health care personnel when faced with caring for persons infected with the human immunodeficiency virus (HIV) more than 25 years after its discovery.

The experiences are documented in a study headed by Lance S. Rintamaki, assistant professor of communication and health behavior in the College of Arts and Sciences, and published recently in the journal AIDS Patient Care and STDs.

“This study reveals the variety of such problematic events,” said Rintamaki, “as well as the considerable array of health care personnel listed by participants in this study. Clinicians should have the training and common sense to avoid a lot of these behaviors, but perhaps we shouldn’t be surprised when hearing about nonclinical staff caught up in these events. They’re likely relying on the same stereotypes and misinformation about HIV that are commonplace among the general public, which may lead them to act in fearful and stigmatizing ways toward HIV-positive patients.”

Persons infected with HIV must spend considerable time in the presence of health care personnel in dealing with their disease, and experiencing stigma can be discouraging. They have labeled dealing with stigma the most significant social and psychological challenge of the HIV experience.

Rintamaki said the handful of existing studies of HIV stigma in health care settings have focused mostly on one type of health care personnel, such as doctors or nurses, and have documented their self-reported attitudes rather than the actual experiences of patients on the receiving end of those attitudes. Those few who have tried to document the frequency of such events have failed to describe the specific behaviors these events entail, he noted.

To take this next step, Rintamaki and colleagues recruited a convenience sample of 50 people seen in the infectious disease units of three Veterans Administration hospitals in the Midwest.

The study was conducted in phases. Eight of the volunteers explained their experiences with stigmatizing behavior in health care settings in two focus groups. Researchers then incorporated these data into one-on-one recorded interviews with the remaining 42 participants.

Interviews were transcribed and experiences were coded and categorized by type of stigmatizing behavior that study participants experienced most often in the presence of health care personnel. These categories were lack of eye contact; assuming physical distance; using disdainful voice tone or inflection; asking confrontational questions; showing irritation, anger, nervousness, fear or panic; taking excessive precautions; scaring, mocking, blaming or ignoring patients; providing substandard care or denying care; and being generally abusive.

Several participants reported only positive experiences with health care providers, while others reported experiencing stigma in a variety of health care settings by a variety of providers.

One participant said he had so little eye contact with his neurologist that he couldn’t describe the doctor’s face, according to the study. Another participant recounted a nurse’s disdain when she delivered his AIDS diagnosis: “It was just so callous and cold the way she said it… ‘You have AIDS.’…There was no feeling. It’s almost like a stone-faced warden or something. No concern.”

Stigmatizing experiences included judgmental behavior and panic on the part of providers when informed of a patient’s HIV status, doctors “hermetically sealing” themselves before approaching the patient and patients being told they were going to die.

Participants described being blamed openly by health care providers for their condition. One patient told of being scolded by a phlebotomist—“If you hadn’t done this to yourself, we wouldn’t have to be going through this!”—when he objected to being “poked” painfully several times as she searched for a viable vein to draw blood.

Other reports included the hospital worker who refused to mop the floor in an HIV patient’s hospital room, the dentist who turned away a patient because of his HIV status and rough handling by paramedics.

“This study reveals that patients are sensitive to such behaviors, indicating the need for all health care personnel to be mindful of their actions toward these patients,” said Rintamaki.

“Given patients’ sensitivity to any indication of bias or discrimination, it’s likely that even well-intentioned health care personnel sometimes engage in behaviors that are interpreted negatively by their patients. The findings from this study give health care personnel additional insights on what to avoid, or if certain protocols are standard procedure, what to explain further. These approaches might help to prevent misunderstandings and hard feelings.”

Additional researchers on the study were Allison Scott and Kama A. Kosenko from the University of Illinois at Urbana-Campaign and Robin E. Jensen from Purdue University.

The study was supported by a Veterans Administration Health Services Research and Development training grant.


Thursday, January 31, 2008

HIV/AIDS and the stigma

By, The Tide Online, January 28, 2008

People living with HIV/AIDS are humans and so should be treated as such. Most times I ponder if malaria is not a killer disease that kills every passing minute of the day. People prefer mingling with those suffering from malaria than those with HIV/AIDS not just a disease like every other?

The number of souls lost through malaria cannot be juxtaposed against that of HIV/AIDS.

Everybody needs love and care whether healthy, infected with malaria parasite or HIV/AIDS virus. The amount of love and care shown to a sick person helps the person psychologically and even physically to fight the disease and to have a quick recovery or even a positive mental attitude towards his situation.

Treating people with HIV/AIDS as outcast is not the best. We do not need to discriminate. They ought to be seen as our neighbours and not seen as the “man next door”.

It is a fact that sleeping in the same room with someone that has HIV/AIDS is not a means of contacting the disease not eating from the same plate with them. The actual means of contacting this so much dreaded disease is mostly overlooked. People have forgotten that HIV/AIDS is transferred through the use and sharing of unsterilised sharp objects like needles, blades and shaving sticks, transfusion of unscreened blood and indulging in what is called “casual sex” without the use of condom.

The fact that man always thinks that evil can only befall his neighbour and not himself has not stopped the unimaginable from happening. Most youths proudly beat their chest and say “I cannot be HIV positive. While they still sow their “wild oats”

HIV is not all about personality that is the way one sees oneself but it is how one is able to control oneself.

Campaigns all over the country have fallen on deaf ears. One of the ills that can befall a nation is ill-health. The HIV epidemic needs the corporations of all and sundry to fight the disease and not sitting to stigmatise.

Regrettably, some of the people that take stigmatisation seriously are HIV positive themselves. Though they have not gone for a test.

Even when HIV/AIDS test is carried out free of charge in our government hospitals now, the fear of the unknown and stigmatisation has restricted a lot of people from queuing for the test at the centres where the test is available.

The provision of Anti-Retroviral Drugs (ARD) to ease the attack of the disease on the white blood cells and the immune system has gone a long way to helping HIV victims live a normal life.

The earlier a person becomes aware that he is a carrier of the disease, the better it is for the person because he receives the medical and psychological treatments available and learns how to cope.

Surprisingly, some victims are shown the door at their place of work because they were able to open up about their status. Some whose status are negative but mistakenly swaped with a positive person’s result are innocently stigmatised. Iragunima is an intern with The Tide.


Monday, January 21, 2008

SUDAN: HIV status a closely guarded secret for most

By, IRIN PlusNews, January 18, 2008

Fadia Awad offers us sweets, a traditional Sudanese gesture of hospitality, and then asks if we are going to refuse them, as all her neighbours do.

She belongs to the Rashaida tribe, a traditionally nomadic people who migrated to eastern Sudan from the Arabian Peninsula in the nineteenth century. She and her son, Hamid, 8, live alone in a spotless, one-room hut in a desert settlement outside Kassala, in eastern Sudan.

"Three years ago this house was full of women cooking, talking and laughing," Awad tells IRIN/PlusNews. "But since I got sick, they don't come anymore."

Her husband died from an AIDS-related illness three years ago, not long after returning from military service in Saudi Arabia. She and her son are both HIV positive, but have been healthy since beginning antiretroviral (ARV) treatment two years ago.

"In this tribe, everyone knows your business," Awad says matter-of-factly. "We've been completely isolated." She points to a hut visible from her window. "My husband's relatives live nearby, but I have no relationship with them anymore."

The night before, we had attended the wedding in Kassala of an openly HIV-positive man, Alsawi Ali, to an HIV-positive woman from Khartoum. Ali, the head of a local association for people living with HIV/AIDS (PLWHA) who regularly talks about his status at awareness events, was surrounded by friends eager to congratulate him and shake his hand.

Sadly, Ali's status as a respected member of his community is still a rarity for people living with HIV in northern Sudan, while Awad's experience is closer to the norm.

"There was very little engagement on HIV until a few years ago," said Severine Leonardi, HIV/AIDS manager for the UN Children’s Fund (UNICEF) in northern Sudan. Although the government is now putting its weight behind prevention campaigns, talking openly about HIV is still difficult in the conservative northeast of the country.

Ali's services as a guest speaker were much in demand at the numerous World AIDS Day events in Kassala during December 2007. According to Musa Bungudu, the UNAIDS country coordinator, "Kassala is one of the states that's a little ahead" in terms of AIDS awareness efforts, but in rural areas, such as where Awad lives, evidence of this progress is hard to find.

Hamid's HIV infection means he has no playmates and does not attend school. "Everyone knows about his father and his story, and I'm afraid they'll abuse him," Awad explains. "He tried going to the religious school, but the other boys refused to share a classroom with him so he dropped out."

Even Awad's attempt to make an income from three goats given to her by a non-governmental organisation failed. "No one would buy the milk, so I sold them," she says.

In Port Sudan, on the country's Red Sea coast north of Kassala, six men aged between 20 and 30 died of AIDS-related illnesses in one week during December, all patients at the city's main hospital. Jhalid Sharif, who runs the local branch of the Sudanese Association for People Living with HIV, said only one of the bodies was collected by the deceased's family; the association had to arrange for the collection and burial of the other five.

Fear of such stigma and discrimination prevents many people from revealing their HIV positive status, even to close family.

Hassan Mokhtar [not his real name], 34, from Kassala, learned he was HIV positive over a year ago, but has not told anyone in his family and is careful not to be seen when he enters the clinic to pick up his antiretroviral (ARV) drugs. "I know other HIV positive people who were rejected by their families," he says. "I expect mine would do the same."

''I know other HIV positive who were rejected by their families; I expect mine would do the same.''
Those involved in Sudan's anti-AIDS efforts also worry that the fear of stigma is preventing people from being tested for HIV, and even from seeking life-prolonging ARV treatment.

Although free treatment is slowly becoming available at public health facilities, the problem is getting more people to use them. "Some people will travel to another state to get treatment to avoid being recognised," Ali says.

He recalls one case where a man had been travelling 600km to Khartoum every two months to pick up ARV drugs until he ran out of money to make the journey. "He would have dropped out of treatment if I hadn't gone to the clinic [in Kassala] and got the drugs for him."

So far, the PLWHA association in Kassala only has eight HIV positive members, including Awad and Mokhtar. Ali says high levels of illiteracy, as well as stigma, prevent more PLWHA from getting involved, and some of those who find their way to the association are only willing to speak in closed workshops or at awareness events far from their homes.

The association receives some financial support from ACORD, an international humanitarian organisation, but it has no fixed budget and no vehicle. "Sometimes people from rural areas request us to do awareness activities but we can't because we lack transport," Ali says.

The association in Port Sudan also has eight members living with HIV, one of whom was seriously ill in hospital when IRIN/PlusNews visited. "He was on treatment but he stopped taking it for two months because a watermelon seller told him he had a very good treatment for HIV," Sharif tells us. "The remedy was made of honey and grass."

Lack of financial support and an office where members can meet are problematic, but stigma is the biggest barrier. According to Sharif, "There are many, many people who are in hospital [with AIDS-related illnesses] who are not involved with the association."



Thursday, September 27, 2007

Angola: HIV positive people demand rights

By, IRIN PlusNews, September 26, 2007

For Father Luํs Fernandez, of the Sacred Heart of Jesus parish in Luanda, capital of Angola, a visit to the market is often all it takes to find out what life is like for people living with HIV.

"How many times have we been called to intervene because a poor woman can no longer sell or buy simply because it has been discovered that she has the virus?" he said.

HIV-positive Angolans suffer a whole spectrum of human rights violations, including discrimination at work, lack of medical treatment and prejudice.

The country has a national HIV prevalence rate of about 2.5 percent in a population of approximately 16 million, although infection rates vary widely by region, with some as low as 1.8 percent and others as high as 10 percent.

Illegal firings

Since 2004, Angola has had laws that guarantee rights for people living with HIV yet infected workers often lose their jobs, still have difficulty finding employment and experience discrimination in workplaces.

"We receive various cases that have already been forwarded to the justice system, but none have been adjudicated," said No้ Mateus, a representative of the Network of People Living with HIV/AIDS in Angola.

Mateus suspects that many illegal dismissals are taking place at private companies, without consequences for the employers. He attributed their impunity to the lack of information HIV-positive people have about their rights, businesses seldom having a facility for dealing with complaints, and the sluggishness of the legal system.

"The slowness of the courts is discouraging. Complainants have to reveal their HIV status, deal with the stigma, and then wait years before a judgment comes down," Mateus told IRIN/PlusNews.

Despite statements from government that it supports labour and business initiatives to protect people with HIV, data based on complaints made by workers to the Ministry of Work and Social Security shows that many businesses disregard the law, demanding that workers reveal the results of HIV tests and firing those who are positive.

Obstacles to treatment

Poverty is entrenched in Angola, despite its oil-powered economic growth. Twenty-seven years of civil war took their toll on infrastructure and social services, and the UN Development Programme's 2006 Human Development Index ranked it at 161 out of 177 countries.

The situation for people living with HIV is especially severe. "What troubles me the most is seeing people die for lack of nutrition," said Elizabeth Santos, 43, who was diagnosed with HIV nine years ago.

"Many people take antiretrovirals (ARVs) while hungry. At the end of the day society will say that these people died of AIDS, but what killed them was being on therapy without also having enough food," she commented.

Taking ARVs without adequate nutrition can compromise treatment, and AIDS activists have urged the government to guarantee a basic package of foodstuffs for destitute patients taking the drugs.

Activists are also calling for the construction of a new public health facility specialising in HIV and AIDS treatment. The Esperan็a Clinic, the only specialised public clinic in Luanda, is too small to meet rising demand.

"It isn't discrimination to have a hospital specialising in HIV, since at many general clinics we have to deal with stigma, even from doctors. In a hospital especially for HIV we would have quality help and we would feel more at ease," said Henda Graciana, an HIV-positive AIDS activist.

Starting with the basics

Lack of information about HIV and AIDS is still one of the major reasons for stigma, especially in remote areas, while prejudice by officials in public institutions often makes it difficult for HIV-positive people to speak out about abuses.

"We need to think of incentives; create the conditions for people with HIV to come forward for help. Because of prejudice, many people just suffer from discrimination and don't bother going to competent authorities," said Roberto Brant Campos, a partnership and social mobilisation consultant for UNAIDS. He added that voluntary testing should provide an opportunity for HIV-positive people to become familiar with their rights.

Father Fernandez pointed to a need to bolster the legal infrastructure for dealing with discrimination cases. Some cases from his parish have been forwarded to the National Criminal Investigation Directorate, but with little result.

"We need to guarantee that there are people with specialised knowledge in dealing with these cases, with a sense of respect and as a way of building more confidence in the system among people with HIV," he said. Fernandez also recommended more community-based interventions, saying, "We need to change the picture."

Guaranteeing the rights of people living with HIV is an urgent concern in Angola, but Odete Tavares, an HIV-positive nurse, suggested that "It would be more realistic to start from the principle that we are citizens, with the right not to be discriminated against, to have access to medication and other basic necessities."