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Stigma and Discrimination Towards People Living with HIV: Sociocultural Aspects, Experiences, and Ethical and Legal Responses in Colombia

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Stigma, Discrimination and Living with HIV/AIDS

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Abstract

Stigma and discrimination towards individuals infected with HIV or AIDS have been recognized as worldwide issues, but they show specific characteristics among different socioeconomic and cultural contexts. It is a complex and dynamic process whose genesis, manifestations, and consequences are influenced by different elements that interact from biological to social dimensions, affected by prejudice and social inequalities. The approaches for the explanation and understanding of these processes have been diverse: theoretical reflections through historical, psychological, social, or mixed focuses and empirical tests through quantitative and qualitative research.

In this chapter, we discuss issues related with HIV infection in the world and Colombia, based on a review of empirical research and different conceptual approaches to theories of stigma and discrimination in health, reported in local and international literature. We reviewed the medical, political, social, and cultural aspects that underlie stigma and discrimination associated to HIV infection, as well as the ethical and legal regulatory responses, and explored their relationship with the perceptions of those who suffer experiences related to stigma and discrimination worldwide and in Colombia. Our review and hermeneutical analysis of the rulings of the Colombian Constitutional Court in response to the writ for the protection of fundamental rights filed by people living with HIV, illustrates with examples the rifts and gaps found between ethical and legal theories based on fundamental rights and the right to health in Colombia.

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Notes

  1. 1.

    The new guidelines establish a CD4 count of 350/mm3 as the lower limit to begin treatment, in comparison to the previous count of 200/mm3.

  2. 2.

    By 2009, 8 of the 144 median and low income countries included (Botswana, Cambodia, Croatia, Cuba, Guyana, Oman, Romania, and Rwanda) had accomplished universal access to antiretroviral therapy (coverage of at least 80 % of the population that needs the treatment), and 21 had accomplished a coverage between 50 and 80 % (Argentina, Benin, Brazil, Chile, Costa Rica, El Salvador, Ethiopia, Georgia, Lao People’s Democratic Republic, Mali, Mexico, Namibia, Papua New Guinea, Senegal, Slovakia, Suriname, Swaziland, Thailand, Tunisia, Turkey, and Zambia).

  3. 3.

    Abadía-Barrero and Oviedo (2009) propose a theoretical and methodological construct that links the personal experience of illness with the health system's structure called bureaucratic Itineraries and concluded that managed care in Colombia has created complex bureaucracies that delay and limit care, demand legal lawsuits, and lead to negative impacts in the patients’ health and lives.

  4. 4.

    Naomar Almeida Filho introduces the concept of way of life to consider that processes of health-sickness are complex, fragmented, conflictive, sociohistorical, and political. This demands to take into account not only the individual conducts towards health but also sociohistorical dimensions that include social class, social relationships of production, and symbolic aspects of the daily life.

  5. 5.

    In 1991, the Decree 559 was promulgated and it established the rules about integral attention and the duties and rights of the sick people and created the National Council of AIDS. It was abolished in 1997 by the Decree Nº 1543, with an emphasis on the regulations for adequate diagnosis and integral treatment and on the need to establish grounds for the protection of the fundamental rights.

  6. 6.

    The favorable rulings of the Constitutional Court led since 2007 to the acknowledgement of the rights to patrimony, health, pensions, alimentary security, and citizenship to partners of the same sex. The National Management of the National Police promulgated an administrative management in 2009 looking towards “ensuring respect and special protection to the Lesbian, Gay, Transsexual, and Bisexual (LGBT) population in the political frame of police management based in humanism” (Gallego 2011).

  7. 7.

    According to Press Summaries of Onusida 2011 about the book Vocespositivas. Resultados del índice de estigma en personas que viven con VIH presented on September 21, 2011 in Bogotá. This book is the result of the investigation made by Simpaqueba J, Pantoja CP, Castiblanco B, and Avila C, with the support of Onusida, Ifarma, and the Colombian network of people living with HIV or AIDS.

  8. 8.

    Organization of the Colombian State whose function is based on promotion, protection, and diffusion of human rights.

  9. 9.

    Social cleaning in Colombia is a combined strategy of different actors in the conflict, initially directed towards left-wing political groups. Since 1990, its targets have been young drug addicts, drug sellers, prostitutes, effeminate males, travesties, transgender, and transsexuals labeled as “AIDS people” (Gallego 2011: 117–118).

  10. 10.

    In 80 % the sentences were favorable to plaintiffs, and in the majority of those denied, the causes were lack of object due to decease of the plaintiff or superseded event, considering that the entity in demand voluntarily recognized the right.

  11. 11.

    Was created by the Political Constitution, to be in force since July 7 of 1991. It belongs to the judicial branch of Public Power and has the responsibility of protecting the integrity and supremacy of the constitution and reviewing the judicial decisions of the writ for protection of the fundamental rights contemplated in the constitution.

  12. 12.

    www.corteconstitucional.gov.co

  13. 13.

    The T represents “tutela” (Spanish for WPFR) and is followed by the number of registration and then the year.

  14. 14.

    SU means Unified Sentence and this SU gathers seven WPFR.

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  1. Bioethics Program, Universidad El Bosque, Calle 155 N° 9-45 (Apto. 406), Bogotá, Colombia

    Chantal Aristizábal-Tobler M.D., DPH (Cand.)

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  1. Chantal Aristizábal-Tobler M.D., DPH (Cand.)
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  1. School of Public Health, La Trobe University, Bundoora, 3086, Victoria, Australia

    Pranee Liamputtong

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Aristizábal-Tobler, C. (2013). Stigma and Discrimination Towards People Living with HIV: Sociocultural Aspects, Experiences, and Ethical and Legal Responses in Colombia. In: Liamputtong, P. (eds) Stigma, Discrimination and Living with HIV/AIDS. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6324-1_8

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