during the initiation and implementation of treatment programs in resourceconstrained settings. Finally, the integration of prevention and treatment is essential, as is palliative care for AIDS patients in developing countries.

REDUCING STIGMA AND DISCRIMINATION

Stigma and discrimination, often driven by fear, can undermine efforts to treat and care for persons with HIV/AIDS. With HIV/AIDS, fear of illness, contagion, and death can affect not only patients themselves, but also those living with and caring for them, such as family members, co-workers, and health care workers. In addition to the stigma associated with the infection and the disease itself, persons with HIV/AIDS may face the stigma associated with belonging to a specific group, such as homosexuals, prostitutes, injection drug users, or persons engaging in “casual” sex. Stigma can result in silence, denial, ostracism, and violence.

Clearly, these reactions can impact interest in and ability to seek diagnosis and care for HIV/AIDS. Stigma and discrimination can discourage people from finding out about and revealing their HIV status, which in turn can affect prevention and treatment efforts. In Africa, 90 percent of HIVinfected people still do not know of their status (Harries et al., 2002); fear of stigma could be one reason for this. Stigma also can affect the quality of care received by people diagnosed with HIV/AIDS. A survey of 1,000 Nigerian physicians, nurses, and midwives, for example, assessed the prevalence of stigma and discrimination (UNAIDS, 2003a). Fully 10 percent of providers admitted to having refused care or denied admission to a hospital for a patient with HIV/AIDS. Almost 40 percent of those interviewed believed that a person’s appearance revealed his or her HIV-positive status, while 20 percent believed that people with HIV/AIDS had behaved immorally and deserved their fate. Factors contributing to these attitudes and behaviors included a lack of knowledge about the virus; a lack of protective equipment, prompting fear among health care providers of acquiring the infection from patients; and frustration at not having medications to treat HIV/AIDS patients, who therefore were “doomed” to die.

Strategies to reduce stigma may include providing information, counseling, imparting coping skills, and promoting social interaction with persons living with HIV/AIDS. It is possible that providing treatment for HIV/ AIDS may decrease stigma by restoring health, which in turn will allow those infected to live symptom-free and engage in work and community activities, and by reducing fear of contagion and death. By providing hope to people living with HIV/AIDS, the widespread availability of ART may reduce the stigma associated with seeking testing and treatment.

Unfortunately, the literature documenting effective methods for reducing the stigma associated with HIV/AIDS in resource-poor settings needs to



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