MY RESEARCH ON HUMAN RIGHTS AND HIV/AIDS RELATED STIGMA AND DISCRIMINATION

TABLE OF CONTENTS:

Acronyms…………………………………………………………………………

Acknowledgement………………………………………………………………

Abstract…………………………………………………………………………

CHAPTER ONE

1.1. Background information…………………………………………

1.2. Statement of the problem………………………………………..

1.3. Literature review……………………………………………………

1.4. Objective of the research……………………………………….

1.5. hypothesis/research question……………………………………

1.6. Significance of the research……………………………………

1.7. Approach and methodology……………………………………



CHAPTER TWO

Awareness of HIV/AIDS stigma and discrimination

2.1. Introduction

2.2. Existing knowledge of stigma and discrimination…………..

2.3. Knowledge of the rights and entitlements of PLHA………..

2.4. Relevance of human rights and HIV/AIDS……………………….


3. CHAPTER THREE

Analyzing stigma and discrimination

3.1. Introduction
3.2. Sources and consequences of HIV/AIDS related stigma and discrimination………………………………………………………………….

Sources
3.2.1. Conceptualization of HIV/AIDS……………………………………….
3.2.2. Lack of adequate and appropriate information on HIV/AIDS…..
3.2.3. Role of culture………………………………………………………………
3.2.4. Poverty………………………………………………………………………..
3.2.5. Role of the media……………………………………………………..

3.2.6. Effect of stigma and discrimination on individual PLHA and those infected by HIV/AIDS

3.3. How stigma and discrimination manifest………………………..

3.3.1. Individual level………………………………………………………

3.3.2. Community level……………………………………………………………

3.3.3. National level stigma and discrimination………………………….

3.3.4. Policy and legal context………………………………………………….

3.3.5. Institutional context……………………………………………………….

3.3.5.1. Employment and the work place……………………………………..

3.3.5.2 Health care system……………………………………………………….

3.3.5.3. HIV/AIDS programs……………………………………………………………..

3.3.5.4. Religious institutions…………………………………………………………..

3.4. Gender defined marginalization and discrimination of PLHA
4. CHAPTER FOUR

Policy and legal environment on HIV/AIDS related stigma and
Discrimination…………………………………………………………….

4.1. Introduction
4.2 national laws and policies on stigma and discrimination…

4.3 awareness on national laws and policies on stigma and
Discrimination…………………………………………………………………..

4.4 enforcement of laws and policies on stigma and
Discrimination…………………………………………………………………..

CHAPTER FIVE

Research findings and analysis.

5.1 The findings………………………………………………………………

CHAPTER SIX

Conclusion and recommendation
6.1. Introduction…………………………………………………………………
6.2. Conclusion……………………………………………………………
6.3. Recommendations…………………………………………………………

Reference…………………………………………………………………….















DECLARATION

I, KISILI IBRAHIM, do hereby declare that this research report is my own original work and it has not been submitted to this or any other University or any institution of higher learning education for degree qualification before the submission date of this report.



Student’s Signature……………………………………..

KISILI IBRAHIM
Date………10-3-2008…………………………………………….





























COPYRIGHT

This dissertation is a copyright protected under the copyright and Neighboring Right ACT N0.7 of 1999 and other international and regional and national enactment in intellectual property. Therefore it may not be reproduced by any means, in full or in parts, except for short extracts in fair dealings for research or for study, critical scholarly review or discourse with acknowledgement without prior authorization of the author or Mzumbe University on that behalf.


©KISILI IBRAHIM











































ACRONYMS:

AIDS Acquired Immune Deficiency Syndrome

ACORD Agency for Co-operation and Research in
Development


ART Anti-Retroviral Therapy.
ASO AIDS Service Organization
BDH Biharamulo Designated Hospital.
FAIDERS Facilitated Intergrated for Development and
Resources Services
HIV Human Immune Deficiency Virus
IEC Information Education Communication
MDG Millenium Development Goals.
NGO Non Governmental Organization
NMSSF National Multi-sect oral Stretagies.
PLHA People Living with HIV/AIDS.
SBO Society Bases Organization.
TAWOLIHA Tanzania Women Living with HIV/AIDS
UNGASS United Nation General Assembly Special
Session.
VCT Voluntary Counseling Testing










Acknowledgement.

A work such as this invariably accumulates many debts. I gratefully to many people for their assistance, inspiration, and support in many ways throughout the conduct of the study and writing of this report. I cannot possibly mention all of them. However I would like to mention a few of them for their invaluable assistance in one way or another. These include Hon.K.M.Mrisho who is the Principle District Magistrate at Biharamulo for his experience direction to my research and assistance in organization of my research paper.

Also I wish to register my sincere gratitude to Biharamulo Designated Hospital especially Teonestina Katonda for her willingness to give me information concerning my research, Mr Edwin who is the program officer (FAIDERS),Biharamulo District Council particularly Legal Officer for his assistance he gave to me. Also I wish to thank SHIDEFA + at Biharamulo, Nyamahanga Child Center at Biharamulo and others.
I most sincerely feel indebted to my supervisor Dr.Kagirwa to his tireless guidance and creative contribution of ideas and material support in all the stage of the research that led to the final conclusion of this work.
Last but not list, I would like to extend my acknowledgement to my family members, Mr. and Mrs. A.M. Kisili, and let me take this opportunity to thank my Mother who had passed away 2001 my Almighty God make her rest in peace, my sister Fatma, my young sisters Rukia, Ziada and Maridhia for their moral and material support which contributed much to my studies at Mzumbe University and during my field attachment. To whom of you please accept my appreciation, your contribution was so immense that would be sheer selfishness to dispassionate you from whatever award that will accrue to me as a result of this work.
However, I remain personally responsible for the the errors and omission, which might be appearing in this report.















Abstract:
HIV/AIDS infection takes many paths and has adverse implication for several families’ members and multiple generations. HIV/AIDS can lead to acute illness and premature death of parents or children or family members may remain healthy and symptom free, yet living under uncertainty for years. As the disease change from life illness threatening to a chronic one, the effect of this change on families requires thoughtful attention because the long haul chronic illness generates additional problems for families.

Human rights provide a legal frame work within which laws, policies, and services can be formulated and assessed as well as an approach to the design of policies and programs. It is incumbent upon government worldwide to translate their international level commitments to the rights into national laws and policies that promote and ensure the rights among the population, including HIV positive people.

Discrimination and stigmatization remain pervasive for people PLHA to access their right, it is essential to have supportive laws policies and programs that prevent and mitigate violence, stigma, and discrimination and that promote gender equity, human rights, and social justice. Laws and policies on non discrimination should specifically name HIV/AIDS.

Protection against discrimination on the basis of HIV/AIDS status within national laws and policies must be assured national laws and policies in order to protect the rights and health of PLHA.
Human rights focus on the following approach attempt to prevent legislation that would discriminate against people with HIV/AIDS and encourage legislation that would strengthen institutional laws legal protection for PLHA.Also change of laws that intentionally discriminate as well as Tanzania Evidence Act and Criminal Procedure Act which do not intentionally discriminate but nevertheless violate the HIV victims privacy and non disclosure policies regarding groups that are vulnerable to HIV infection.

















1. CHAPTER ONE:
1.0.1. BACKGROUND INFORMATION.
Human rights are fundamental rights which a person has by virtue of being a human being. They are not dependent on being provided for in a particular document. These rights are inherent and therefore they should be recognized, respected, and enforced. In Tanzania human rights are inherent as it was explained in the case of REV.CHRISTOPHER MTIKILA V.ATTORNEY GENERAL that ´´fundamental rights are not gift from the state. They inhere in a person by reason of his birth and are therefore prior to the state and the law``. In Tanzania the Constitution has enacted fundamental rights in its provisions. This does not mean that the rights are thereby created rather it is evidence of their recognition and the intention that they should be enforceable in a court of law.
Human rights are universal, inherent and inalienable. There cannot bee different standards of human rights, norms and standards for different categories of people. In addition it is in the interest of all to protect the rights of those with HIV/AIDS. The rights based prevention approach recognized social vulnerability to HIV/AIDS, not just individual risk behavior. It also recognizes vulnerability in different contexts of stigmatized or disempowered populations, such as women, children, and injecting drugs users.
Acquired Immune Deficiency Syndrome (AIDS), hereinafter referred to as AIDS, was first reported in 1981 in the United State of America. It has been in Tanzania Mainland for 24 years now since early 1983 when the first case was reported. The first three AIDS cases were reported in 1983 in Kagera Region. By 1986 all 20 regions in Tanzania mainland had reported AIDS cases.

Around the world,
Over the past decade in the pre-Antiretroviral Therapy hereinafter referred to (ART), era over 20 million people all over the world have died due to HIV/AIDS. Today in the era of ART over 40 million people are living with HIV/AIDS world wide . The innovation of ART has brought relief and hope in the lives of persons living with HIV/AIDS and their families. The impact facing the people living with HIV/AIDS at family level has affected in various ways both directly and indirectly and these can be categorized as psychological, economical, or social.
HIV/AIDS is also associated with stigma and repression. Stigma has henceforth been a powerful tool of social control. The disease has in many cases reinforced this stigma. Those infected are sometimes punished or ostracized contrary to the rights provided for in the Constitution and several national policies. In some cases the disease has been seen as a result of personal irresponsibility. For instance a mother with HIV/AIDS said ´´if our neighbors found out my HIV status they could make us uncomfortable. Their children may haunt my daughters``.She also states that ´´one doctor reacted negatively and fearfully, she is always washing her hand when she sees my child``.
Persons and families with HIV/AIDS are vulnerable to rejection and feelings of guilt. Discrimination occurs in housing, jobs, health care and public assistance due to both categorizing and prejudice. Because of discrimination many people living with HIV/AIDS have been denied their rights of employment, an abuse to social protection code and a right to employment. This has affected families with people living with HIV/AIDS massively when people living with HIV/AIDS are forced to leave their job and are isolated in their families.

1.0.2. STATEMENT OF THE PROBLEM:
In Tanzania the stigma and discrimination of people living with HIV/AIDS is evidenced in many settings including people living with HIV/AIDS and affected families, media, workplace, the education and health sectors, and religious institutions. Stigma and stigmatization impede HIV/AIDS prevention measures and support services.Breaking the silence on HIV/AIDS becomes a problem as the people living with HIV/AIDS and affected families live in fear and a state of denial lest families and communities around them know their HIV status. There are a lot of examples where at family level or at homes of people living with HIV/AIDS one finds stigmatization, ostracism and even abandoned by their families or partners. Such treatment is attributed to religious or cultural moralization related to HIV/AIDS. People living with AIDS are regarded as sinners or witches deserving punishment for their evil deeds. People living with HIV/AIDS have been experiencing problems with housing both in the public and private sector markets. Some have been refused accommodation, evicted, and have other forms of discrimination and harassments. Hence people living in isolation and can not access to social support services, a factor that infringes upon their constitutional rights.
The concept that AIDS as a killer is noted to be the genesis of HIV/AIDS related stigma and discrimination. The stigma is deeply rooted in the main prevention massage for HIV that ´´ukimwi unaua``meaning AIDS kills or ´´no cure``.The words used to refer to people living with HIV/AIDS as having stigma include ´´ngoma, umeme, kanyaga miwaya``.Some people consider people living with HIV/AIDS as having bad luck (mkosi) and their families wish them to die faster so as to rid the family of bad luck.
In general the United Republic of Tanzania Constitution provides for protection of rights of people living with HIV/AIDS. But in specific terms there appears to be no any legislation that directly protects the rights of people living with HIV/AIDS. The policy and legal environment on HIV/AIDS related stigma and discrimination can be traced in the available country policies. Among them are Community Development Policy , National Policy on HIV/AIDS and National Multi-Sectoral Strategies Framework on HIV/AIDS
However, lack of adequate awareness of these policies propagates the marginalization of people living with HIV/AIDS. There is little evidence of deliberate efforts on the part of the government to popularize policies and laws that spell out the rights of people living with HIV/AIDS.



1.0.3. LITERATURE REVIEW:
It has been increasingly recognized that health and human rights are complementary, interdependent, mutually reinforcing, rather than conflicting goals. Both share common objective of promoting and protecting the dignity and well being of all individuals. As far as HIV/AIDS is concerned the promotion and protection of human rights is a crucial element in the response to HIV/AIDS because HIV/AIDS thrives upon and in turn worsens situations that are prone to human. rights abuses .
According to Mukoyogo M.C. although HIV/AIDS was diagnosed in 1981 a systematic international and national response to the epidemic was not evident until late 1986.In 1980s the relationship between HIV/AIDS and human rights was only understood as it involved people infected with HIV and with AIDS and the discrimination to which they were projected. People affected with HIV/AIDS are often referred to as sinners or witches deserving punishment for their evil deeds. It is from that notion explained above, the concept of ‘them’ and ‘we’ arose as the bases of discrimination. While the ‘us’ are mainly people who are either HIV/AIDS negative or do not know their HIV status, the ‘them’ are those who are HIV/AIDS infected people in our societies and communities. This is the very basis for stigma and discrimination against for people living with HIV/AIDS.
According to Gabriel Jangwe and Chris Columbus Opesen, although HIV/AIDS is predominantly recognized as a health problem for the individual, the epidemic has multiple psychological and economic dimensions and implications on the families. Families have been affected in various ways both directly and indirectly and these impacts can be recognized psychologically, socially or economically.
According to Nicole Grimm , commonly reported HIV related human rights violations include discrimination, when trying to obtain inheritance, inadequate medical treatment and mandatory HIV testing and disclosure of HIV status to employers. In additional to tangible human rights abuses many HIV/AIDS patients are rejected by their families.
Pursuant to the Bills of Rights enunciated in the Constitution of United Republic of Tanzania in 1984.Antidiscrimination principles in relation to one’s HIV status are stipulated therein under general provisions.Article13 (4) of the constitution of United Republic of Tanzania provides that ‘no person shall be discriminated against by any authority acting under any law or in the discharge of the function or business of any state office’. Also Article 13(5) provide among other thing that ‘discrimination means to satisfy the needs, rights or any other requirements of different persons on the basis of their nationality, tribe, place of origin, political opinion, colour, religion or station in life such that certain categories of people are regarded as weak or inferior and are subjected to restrictions or conditions whereas persons of other categories are treated differently or are accorded opportunities or advantage outside the specific conditions or the prescribed necessary qualification. The Bills of Rights recognizes the principle of equality before the law. The right to life is enshrined tide herein. By recognizing anti-discrimination principles the human rights for people living with HIV/AIDS are well protected under the Constitution of United Republic of Tanzania. The issue now is the enforcement of these human rights to adequately address stigmatization and discrimination against people living with HIV/AIDS by the communities and in various sectors.
1.0.4 OBJECTIVES OF THE RESEARCH
General objective
The research aimed to identify gaps and barriers created by existing national policies, national legislations, governmental designed programme on HIV/AIDS in Tanzania and make appropriate recommendations for future policy or programme review and or redesigning those program, and review of some existing laws which infringes the rights of people living with HIV/AIDS.
Specific objectives.
-It tries to identify the forms HIV/AIDS related stigma and discrimination which take place in Tanzania especially at Biharamulo district within Kagera region, the context it occurs and its various determinants.
-It appraises the link of HIV/AIDS related stigma and discrimination in Tanzania to broader inequalities, injustices and denials of individual realization of Human rights and fundamental freedom.
1.0.5. HYPOTHESIS AND RESEARCH QUESTION:
Human rights are universal legally guarantees protecting individual and group against actions that interfere with fundamental freedoms and dignity.
I. HIV/AIDS related stigma and discrimination is a violation of the fundamental rights of people living with HIV/AIDS as a human being.
II. Is there any need to have a law and or policies which will protect the rights of people living with HIV/AIDS?



1.0.6. SIGNIFICANCE OF THE STUDY:

A review in Tanzania shows that very few studies on HIV/AIDS related stigma and discrimination had looked at the forms, consequences, context and determinants of HIV/AIDS related stigma and discrimination against people living with HIV/AIDS.
Considering that, very little has been done on analyzing the effects of policies and pronouncement on HIV/AIDS related stigma and discrimination on human rights against people living with HIV/AIDS.
The significance of this research is to try to show the forms, context, and forms of HIV/AIDS related stigma and discrimination against people living with HIV/AIDS in Tanzania in general.
1.0.7. RESEARCH DESIGN AND METHODOLOGY:
The research is designed to establish base line understanding of socio economic and cultural environment in which people living with HIV/AIDS live while exercising their basic rights in relation to communities and institution sectors.
I. Study area and participants :
The study targets the community and institutions in Biharamulo district in Kagera Region. Specifically the study target the stakeholders, including selected society bases organizations (SBO), and people living with HIV/AIDS support groups at community level and community leaders at village, ward and district level.




II.Data collection:
Data for this research will be collected using qualitative methods. These methods include key informant interview, and desk review.
a. Key informant interview will be conducted to community leaders at district levels, doctors, students and people living with HIV/AIDS. Guide will be designed to cover the issue on stigma and discrimination against People living with HIV/AIDS and a local government interfacing with people living with HIV/AIDS and AIDS Services Organizations
b. Desk Review. Secondary information that the study will review the policy and legal surrounding HIV/AIDS related stigma and discrimination at local level.

Component of the study are;
-Baseline survey to determine the key issues, factors and determinants of HIV/AIDS related stigma and discrimination in Tanzania.
-Analyses of key policies, pronouncement and programme on HIV/AIDS on stigma and discrimination in Tanzania especially Biharamulo district.








CHAPTER TWO.

AWERENESS OF HIV/AIDS RELATED STIGMA AND DISCRIMINATION

2.1. INTRODUCTION

This chapter analyses the existing knowledge between stigma and discrimination, knowledge of the rights and entitlements of PLHA. Moreover this chapter ends with the relevance of human rights and HIV/AIDS

2.2. Existing knowledge between stigma and discrimination.

Stigma is defined as “a powerful and discrediting social label that radically changes the way individuals view themselves and are viewed as persons. It can be felt (internal stigma), leading to an unwillingness to seek help and access resources, or enacted (external stigma), leading to discrimination on the basis of HIV status or association with someone who is living with HIV/AIDS” (Siyam'kela, December, 2003). Guided by this understanding, the study attempted to assess people’s awareness and knowledge of HIV/AIDS related stigma and discrimination.

The study findings reveal that stigma is a social construct; it is a lens through which society sees and interprets the condition of having and living with HIV and AIDS. This social interpretation [of the condition of having and living with HIV and AIDS] therefore defines social relationships between persons known or perceived to have HIV and those thought or known to be free of the virus that causes AIDS. In the final analysis, it is such social relationships that can be described as discriminating or marginalizing people living with HIV and AIDS (PLHA).

HIV/AIDS related stigma and discrimination starts from having some knowledge of HIV/AIDS. All study participants knew about HIV and AIDS and the majority had ever seen someone with AIDS . A good number of participants in the interview observed that AIDS was a big problem in their community. Other participants noted that there were many PLHA in their villages, but were not willing to disclose their status, while some community members were in hospitals due to HIV/AIDS related illnesses. It was a positive finding that there are Swahili (the national and official language of Tanzania) translations for stigma (unyanyapaa) and discrimination (ubaguzi) which is a step towards tackling stigma and discrimination as it makes it easier to explain these issues to the common and illiterate person. Thus all study participants knew about HIV/AIDS related stigma and discrimination; they also displayed good knowledge of the manifestation of stigma and discrimination.
Although participants had this basic knowledge of stigma and discrimination including the Swahili translations, most of them could not easily and clearly discern the link between stigma and discrimination on one hand and increased prevalence of HIV on the other. Only the primary effects of stigma and discrimination were widely known. Primary effects are those that affect the individual PLHA as opposed to secondary effects which affect the rest of the community e.g., intentional and unintentional spread of the virus by PLHA as a response to stigma and discrimination by society.

Equally missing was clear information on the causes of stigma and discrimination. The widely cited cause was community ignorance (especially lack of update information) of the epidemiology, prophylaxis and prognosis of HIV and AIDS including the individual, home and community management of the epidemic. Lack of this information is potentially an underlying factor that perpetuates tendencies of stigma and discrimination of PLHA in community. There was consensus in this participatory study among various participants that demystification of HIV/AIDS as a killer disease is a gradual process; arguing that it will take time to alter some people’s attitude towards people infected and affected by HIV and AIDS.

2.3. Knowledge of the rights and Entitlements of PLHA:

In as much as there is less awareness of the rights of PLHA, even among those with some knowledge of these rights, there is no consensus on whether the PLHA should have special rights at all. On one hand was a category of participants who thought that human rights belong to every human being, infected or not. On the other hand were those who thought that PLHA “are in a disadvantaged position” because of their health condition which have negative effects on their livelihood, therefore deserve special rights, although some suggested privileges rather than special rights. One participant had this to say:

I think PLHA should have additional privileges instead of special rights. Thus there should be privileges solely for PLHA e.g., for the aspect of special diet, Male member of SHIDEPHA+, Biharamulo

Other participants observed that PLHA need special rights to guarantee some additional income, because of reduced productivity and special rights to guarantee medical care without any discrimination. Some of the PLHA met in Biharamulo district noted that although they know their rights, they do not know where to seek redress if such rights were violated or not respected.
Box 1: Rights of PLHA rights as mentioned by City (compare with rights under 5.2.3)
Right to life
Right to marriage
Right to be valued
Right to medical services
Right to education
Right to contribute their views
Right to confidentiality; it is illegal for another person to declare public sero status of PLHA without their consent
PLHA have a right to continue with their employment [in spite of their HIV status]

Source: Focus Group Discussion, Nurses at BDH

Overall, the study findings revealed higher awareness of PLHA rights among people involved in PLHA care and support and those PLHA who are organized under support groups e.g., those under TAWOLIHA and SHIDEPHA+. On the other hand, knowledge of PLHA rights is almost non-existent among community leaders and the ordinary community members. It is worth citing also that even staff of ASOs who have some knowledge of PLHA rights largely lack copies of legal documents that contain these rights and which, can act as training and sensitization materials/manuals.






2.4. Relevance of Human rights and HIV/AIDS

More than 40 million people after the first clinical evidence of AIDS reported, AIDS has become one of the most devastating diseases human kind has ever faced. Since the epidemic began more than 45 million people have been infected with the virus. HIV/AIDS has become the fourth largest cause of death worldwide. At the end of 2006 an estimate of 30 million people were living with HIV/AIDS.
Human rights are inextricable linked with the spread and impact of HIV/AIDS on individual and communities around the world. A lack of respect for human rights fuels the spread of and exacerbates the impact of the disease, at the same time HIV/AIDS undermines progress in the realization of Human rights. This link is apparent in the disproportionate incidence and spread of the disease among certain groups which depending on the nature of the epidemic and the prevailing social, legal and economic condition include women and children and particularly those living in poverty.

It is also apparent in the fact that the overwhelming burden of the epidemic today is born by developing countries where the disease threatened to reverse vital achievement in human development. AIDS and poverty are now mutually reinforcing negative forces in many developing countries.
Increased vulnerability, certain groups are more vulnerable to contracting the HIV virus because they are unable to realize their civil, political, economic, and social cultural rights. For example individual who are denied rights the rights of freedom of association and access of information may be precluded from discussing issue related to HIV/AIDS, participants in ASOs, and self help groups, and taking other preventive measures to protect themselves from HIV infection. Women and young women are more vulnerable to infection, they lack of access information, education and services necessary to ensure sexual reproductive health and prevention of infection.
Discrimination and stigmatization, the rights of PLHA are violated because of their presumed or known HIV status, causing them to suffer both the burden o the disease and the consequential joss their rights. Stigma and discrimination affect their rights. Stigma and discrimination may obstruct their access to treatment and may affect their employment, housing and other rights. This in turn lead to vulnerability to other infection, since HIV related stigma and discrimination discourages individuals infected with and affected with HIV/AIDS from contracting health and social services, the result is that those most needing information, education and counseling will not benefit even where such service are available.
Impedes an effective response, in the environment where human rights are not respected then strategies to combat HIV/AIDS epidemic will not be hampered. For example discrimination against and stigmatization of vulnerable groups such as infecting drug users, sex workers, and men who have sex with other men drives these communities underground. This inhibits efforts and thus increases their vulnerability to HIV/AIDS. Failure to provide access to education and information about HIV/AIDS or treatment and care, support services further fuel HIV/aids epidemic.
These elements are essential components of an effective response to HIV/AIDS which is hampered if these rights are not respected.
When individuals, communities are able to realize their rights to education, free association, right to education and most importantly non discrimination the personal and societal impact of HIV/AIDS are reduced. When an open and supportive environment exist for PLHA, where they are protected from discrimination, heated with integrity, and provided with access to treatment, care and support and where AIDS is de- stigmatized , individual are more likely to seek testing in order to know their status. In turn those people who are HIV positive may deal with their status effectively by seeking and receiving treatment and psychological support, and by taking measures to prevent transmission to others, thus reducing the impact of HIV/AIDS on themselves and on society at large.

In nutshell, Prevention and promotion of human rights in order to fight against HIV/AIDS is very important. The reason here is this it reduce vulnerability to infection by addressing its root causes, the adverse impact of those infected and affected of HIV/AIDS, individual and communities have greater ability to respond to pandemic. An effective international response to the pandemic in accordance with international Human rights standards, norms and principles.








CHAPTER THREE.
3.1. INTRODUCTION
The sources of HIV/AIDS related stigma and discrimination in the community and institutions are diverse and mainly stem from the way HIV and AIDS is perceived by society. This Section seeks to unravel the intricacies and interrelationships of the factors that cause stigma and discrimination of those infected and affected by HIV and AIDS. The Section also details the consequences of this undesirable reaction and behavior of the community to PLHA.
3.2 Sources of HIV/AIDS Related Stigma and Discrimination

3.2.1 Conceptualization of HIV and AIDS

The conception of AIDS as a killer is said to be the genesis of HIV/AIDS related stigma and discrimination. It was argued by some study participants that stigma is deeply rooted in the main prevention messages for HIV that “Ukimwi unaua” meaning “AIDS Kills” or “no cure for AIDS” as observed by one ASO staff:

If I find that my neighbor has been infected with HIV, I will fear him considering what I have heard on radio, (Female ASO staff, Biharamulo.)

Therefore, among several people AIDS is synonymous with death, and death is naturally feared by mankind and has to be avoided as long as one can. In the eyes of several participants in Biharamulo District someone with HIV and AIDS carries death (or represents death) and has to be avoided. One participant in a group discussion had this to say:

Society considers PLHA as people who will die soon and not a potential for development, which is why they discriminate them (Female nurse, Biharamulo designated hospital)

While it is true that contracting HIV will at one time lead to AIDS and the eventual AIDS related mortality, knowledge of this has overtime created an impression that a PLHA is as good as a “walking corpse” and attracted a host of similar names from society. Words used to refer to PLHA and which smack of stigma include (in Swahili)-Ngoma, Umeme, Kanyanga miwaya. Some people reportedly consider PLHA as having mkosi (bad luck) and their families wish them to die faster so as to rid the family of bad luck.

Therefore, HIV prevention messages while seeking to create fear as a basis for behavior changes, made society to feel that a PLHA is ‘useless’; in terms of procreation and reproduction, the main message was that HIV+ couples would not reproduce themselves. Even such scientific breakthroughs such as the ART and PMTCT which enables HIV+ mothers to have HIV free babies, have not done much (as yet) to convince society that AIDS can be managed and life goes on! For instance, the National Multi-sectoral Framework for HIV/AIDS notes that in Tanzania, it takes about 7 to 10 years for a person to progress from HIV infection to the development of AIDS related diseases and eventually die. One PLHA explained during a group discussion that:

Society feels that AIDS means death. I have said this on radio that getting HIV does not mean death. Some people live for many years with HIV (Male group discussion member, Biharamulo).

From the above it is abundantly clear that information, education and communication (IEC) messages for behavioral change can inadvertently lead to stigma especially those that imply moral decadence on part of those who contract HIV.


3.2.2 Lack of adequate and appropriate information on HIV and AIDS
One the frequently mentioned causes of stigma and discrimination was lack of adequate knowledge on HIV and AIDS especially on stigma and discrimination. There was consensus among the study participants that lack of update information on HIV and AIDS including on HIV/AIDS related stigma and discrimination is one of the main reasons why PLHA suffer stigma and discrimination both at the community and institutional levels. In as much as the community is aware of what HIV/AIDS is, have sufficient knowledge regarding transmission; they are largely not aware of how to live with PLHA as succinctly summarized by a male participant living with HIV/AIDS:

If you disclose that you have HIV some say that “this one is lying, he has just been given money to say such thing (Male group discussion member, Biharamulo)

With HIV and AIDS targeted awareness campaigns, community members are able to discern issues of HIV and AIDS, but with feelings that easily translate into HIV/AIDS stigma or if constructively internalized could contribute positively to reduction of stigma. One male community leader gave an account of what is known of AIDS in his village:

AIDS is a disease that cannot be cured, it is non-selective, which causes problem to the community, it causes less development to the community, it weakens people, it does not choose whether a person is rich, poor, white, black, young, youth, etc. (Focus Group Discussion with Community Leaders, Place: nyarubungo ward)

Thus, if the community is able to conceive of HIV and AIDS as debilitating and leads to death yet it can be managed and that every one stands an equal chance of contracting it, the possibility for stigma and discrimination will be considerably minimized.

3.2.3 The role of culture
Having HIV and AIDS in most cases implies that one went against the established cultural norms of chastity; hence thought of as promiscuous. Such a person who is considered to have brought shame and disrepute to his community and family in particular; discrimination is an appropriate response. Where this person is female, she is thought of as a prostitute. In both cases, society feels that people deviated from sexual restrictions as per the culture and therefore were cursed to get HIV.

Cultural undertones notwithstanding, the fact that some members of society link HIV to sexual intercourse only, is an indicator of ignorance of the different ways through HIV is spread. Lack of adequate and appropriate information on HIV and AIDS has already been cited as one of the sources of stigma and discrimination of PLHA. This perception of the transmission of HIV stigmatizes women as the main carriers of the virus. Where such views are prevalent, there is strong tendency to have domestic violence, divorce and women losing property including land to their husbands and husband’s relatives in case the latter is dead:

I think our culture promotes stigma and discrimination. The culture does not recognize a woman after her husband is dead. Her wealth is taken away, and if she has HIV, she starts getting sick, (Female participants in group discussion, Biharamulo).


3.2.4 Poverty
Poverty foments stigma and discrimination. It was revealed that some people discriminate PLHA so that they avoid spending the little available resources on care for PLHA, which many families find very expensive. One participant observed:
PLHA are seen as an extra burden on the family (because of increased expenditure on medical care and nursing); so some of the families discriminate them so that they can die faster to give a relief to the family (Female Nurse, BDH Clinic, Biharamulo).


3.2.5 The role of the media (i.e., radio, TV and newspapers)
A number of PLHA met in Biharamulo recounted their experiences when they appeared on TV and radio to tell the public about HIV and AIDS and urge them to go for VCT and not to stigmatize and discriminate PLHA. In this case the media plays a positive role in popularizing the cause of PLHA rights and contributes to the reduction of stigma and discrimination of PLHA. But the media is a double edged sword with a potential for developing society or destroying it.

The media has been referred to as the voice of the people, this means that what the media carries is the dominant news on behavior and attitude among other aspects in society. The foregoing findings have indicated the society within the study area stigmatizes and discriminates PLHA, it is therefore unexpected that the media will carry messages that say the contrary. As far back as 2003, ACORD observed that some of the media reports and messages on HIV and AIDS are inherently biased and judgmental, contributing to stigma and discrimination against PLHA (ACORD, March 2003). The following case in Box 3 though in South Africa is applicable in the case of Tanzania, the study area in particular.

Box 1: The media and HIV/AIDS related stigma and discrimination
In the media, PLHAs were represented as sick and dying, ‘promiscuous’. According to some PLHAs, media practitioners have selected only aspects of their stories in order to make their reports more newsworthy, or to make the story fit into their perspectives. Powerful negative metaphors related to HIV/AIDS reinforce stigma and create a sense of otherness. This sets a moral tone that contributes towards people conceptualizing PLHAs as different, and guides thinking toward a ‘them’ and ‘us’ division. When this division occurs, a person is less likely to identify with the other group, in this case PLHAs. For example, metaphors that refers to HIV/AIDS as a plague – and PLHAs by association as the carriers – present PLHAs in a dehumanizing and alien light. Instead of using resources and energy effectively to provide a caring, compassionate response, PLHAs, people representing risk groups, and people affected by HIV/AIDS have become targets for blame and punishment. This has only heightened their vulnerability to HIV/AIDS and pushed them into a vicious cycle of stigmatization and discrimination. Siyam’kela (December, 2003)

3.2.6. Effects of Marginalization on Individual PLHA and those Affected by HIV and AIDS
One of the grave effects of stigma, discrimination and marginalization of PLHA is to undermine the gains made by introduction of antiretroviral therapy (ART). Fear of stigma and discrimination drives a big number of men ‘underground’. This category of men usually have women (wives) who would have declared their HIV+ status to their husbands and have gone ahead to register (and get) free ARVs from a health facility. Because of fear of stigma, the men shy away from testing (including testing for CD-4 cell count, which has been a prerequisite before starting ART), and therefore do not get their own ARVs, instead secretly use their partner’s dose. Thus neither the wife nor the man takes a full dose of the ARVs, which poses a danger of having new virus strains that are drug resistant.





Box 2: Testimony from health service provider, Bihramulo District
A woman came here for VCT, she tested positive for HIV. We measured her CD-4 cell count and gave her some ARVs. The woman went back to her home. After some days of using the ARVs, she noticed some were missing, and later realized that her husband was secretly using them. When she told me about this, I asked her to tell her husband to come for VCT and ARVs. She told me that her husband did not want to be seen going for VCT and ARVs, since he was popular and it would bring him shame.

Another effect of marginalization is compounding the HIV prevention efforts and therefore increasing HIV spread. HIV/AIDS related stigma and discrimination discourages especially men from VCT, disclosure and use of ARVs. Unwillingness to disclose their HIV sero-status on the part of men is linked to livelihoods; if their HIV+ status is made public, there is a well founded threat of losing their jobs and failing to support their families. Some of these HIV+ men end up spreading the HIV virus in some cases, unknowingly. Some women living with HIV/AIDS like the men can also spread HIV in response to stigma and discrimination:

One woman went to test for HIV after her husband died of HIV/AIDS related illnesses, after testing she disclosed that she was HIV positive, but people stigmatized her and she started unsafe sex so as to infect others-in revenge. But this woman is now dead (Female Community Leader, Biharamulo District).

The following is a synthesis of findings in this study relating to what communities mentioned as consequences of stigma and discrimination
PLHA lose peace, they feel so disappointed and some may commit suicide
Loss of sources of income and proliferation of poverty-in Biharamulo District, one female PLHA recounted how she lost her liquor selling business after appearing on TV, customers stopped coming. Other female PLHA narrated their experiences one was selling roast nuts and customers refused to buy from her, while another was selling fish but after a public appearance people refused to buy her fish. During the group discussion meeting where she made this revelation, she was visibly angered by her decision to disclose her status. This makes the issue of livelihoods support all the more necessary to give the PLHA that disclosed another source of income.
Child headed households, increase in street children and homelessness, as there is no one to give care and support; sometimes children whose parents are infected with HIV are literally ostracized by the community
There is a threat of domestic violence sparked off by disagreements on the use (sharing) of ARVs. Divorce was also mentioned as a consequence of discrimination. Where such women are divorced or widows are disposed of their property or they lose their main source of income because of stigma, in absence of nutritional support, there is a threat that such women will discontinue taking ARVs, since this therapy requires good feeding, which they may not be able to afford

Box 3: Consequences of stigma as told by staff of Biharamulo AIDS Outreach,
One of the consequences is death; if the PLHA are stigmatized, they sometimes find no one to take them to hospital, when they fall sick, they easily die
Due to stigma, the family develops a negative attitude; if someone goes to visit them, they think he has come to scorn the patient (PLHA)
Due to stigma, often PLHA find it difficult or are denied the right to write a will before s/he dies
There is a risk of transmitting HIV, since people do not want to accept the reality, they believe in witchcraft [as an escape route to stigma, since witchcraft is socially recognized and accepted]. We once found that all of our client’s family members had been cut using a single razor blade as part of the local belief in witchcraft. In cutting they started with the infected person
Someone who is infected becomes immoral [reckless] due to stigma and becomes confused as s/he thinks that everyone is against him/her due to stigma, so s/he spreads the virus to anyone s/he meets

Alongside the negative consequences, there are cases of PLHA that have resolved to crusade for PLHA rights through elimination of stigma and discrimination.

I thank God, but I think that we have to feel like others. If you are strong keep on working. I was so stigmatized and discriminated to the extent that no one entered my room. Whenever I took a bath, they would pour water in the bathroom to “flash away the virus”; then I asked them, who told you that one can get the virus by sharing a bathroom? (Female PLHA, Biharamulo District).

Indeed, other PLHA revealed that persons who used to discriminate them later came back to them for counseling and guidance on positive living.

3.3. HOW STIGMA AND DISCRIMINATION MANIFEST
INTRODUCTION
This Section traces the different forms of HIV/AIDS related stigma, discrimination and marginalization at community and institutional levels. Knowledge of these aspects can potentially serve as a guide for any systematic intervention during implementation.
Forms and Manifestation of Stigma, Discrimination and Marginalization
Ten levels of the problem of stigma, discrimination and marginalization can be discerned;
3.3.1 Individual level stigma
One of the forms of stigma that participants mentioned was self stigmatization which according to them is due to worries of being stigmatized by society. The individual sees himself as inferior to others because of his condition. He withdraws to himself and always thinks/feels that society is against him. The danger with this type of stigma is that overtime, the victim starts thinking that s/he is always discriminated even when it is not the case. It was claimed that such PLHA take long to appreciate certain good deeds by members of their families, friends or community, which prompts some members of society to comment that “PLHA are hard to please”. For instance, during a group discussion, a big number of the participants believed PLHA have confused minds; one of them had this to say:

I never knew that my son was infected with HIV/AIDS, I only saw him having a confused mind; this young man hated even his close relatives. PLHA are confused due to their health condition, so this disease enters their brain (Community members’ discussion group, Biharamulo District))

The majority of participants in this study agreed that the degree of discrimination and marginalization of PLHA depends on the condition of the PLHA. Thus when the PLHA is still strong and does not show any signs thought of as symptoms of AIDS; such a person is less or not discriminated at all. One local leader was apt enough when he observed:

When PLHA are bedridden they get confused because they realize that they will be down (in bed) for long. (Male Local Leader, Nyarubungo Ward, Biharamulo District)

PLHA are the primary target of discrimination while those affected by HIV and AIDS are the secondary targets. Therefore secondary stigmatization and discrimination are experienced by those affected by HIV and AIDS. This category includes widows, widowers, orphans and other close relatives of the PLHA. It is worth observing that to a certain extent the stigmatization and discrimination that this category suffers is also secondary, which usually includes name calling and teasing of orphans at school. Health and development workers involved in care and support of PLHA have also not escaped the name calling; one such participant lamented that he is referred to as “Mzee wa virusi” meaning “Mr. AIDS”.

3.3.2 Community level discrimination and marginalization
Whereas community people were of the view that people are not discriminated when they are suspected to be HIV positive, most PLHA were of the contrary view. They noted that if someone is known or suspected to be HIV+, the community discriminates him, denies him services such as food, medicine and spiritual counseling services. One PLHA met in Biharamulo District reported that:

Sometimes when you visit and you find people about to eat, they stop-(Female group discussion member, )

Another member in the discussion group with PLHA also in agreement with the above noted:

When you go to borrow say a knife from your neighbor, they lie that they do not have it because they do not want to share their facilities with the sick (Female PLHA,)

Discrimination in health facilities where health officials refuse to provide adequate care to PLHA is also under this category. Nurses met at BDH, revealed that some of their colleagues wear gloves when they attend to known PLHA even when it does not at times involve contact with the person’s body. In Biharamulo District, a health worker revealed that whenever doctors are doing the routine check-up on patients in the hospital wards, if they encounter a known or suspected PLHA, they either spend very little time with the patient or skip him claiming that such a patient has his or her own special doctor, when in actual fact there is none.

Similar cases of health personnel discriminating PLHA were recounted by PLHA met in Biharamulo while other cases have already been a subject of research in other countries. A study in Nigeria found that one in ten doctors and nurses had refused to care for a person with HIV/AIDS or had denied a person with HIV/AIDS admission to a hospital (MacNaughton, 2004). In the same study, 20% of doctors and nurses surveyed believed that people with HIV/AIDS "had behaved immorally and deserved their fate". In the Philippines, it was found out in a survey that 50% of PLHA had experienced discrimination by health-care workers. Similarly, in India it was found out that 70% of PLHA had faced discrimination, usually within their families and in health-care settings (MacNaughton, 2004).

Box 4: Community discrimination of PLHA,
Society has not accepted the AIDS problem; people feel that if someone is found HIV+ he belongs to the organization that gives care and support to him instead of his family. You meet people who have a PLHA in their home and they tell you: “njoo umuhumudie mgonjwa wako”-meaning “come and attend to your patient”. Also, whenever people see us visiting a family, they stop interacting with that family or if at all, it is minimal. When they see our car parked at someone’s residence they suspect that there is a PLHA in that home. So some people have told us to always leave our vehicle at a distance whenever we go for home visits, so that their neighbors do not recognize us.

At community/institutional level PLHA do not get a chance to air out their views freely; either they are completely denied an opportunity of airing their views, or when they get the opportunity, their views are not heard-a euphemism for not taken seriously. For instance, while all participants agreed that legally PLHA are entitled to compete for elected offices, they do not stand any possibility of success if they disclose their sero status. Under decentralized governance and community development, there are committees where there should be equal representation including of interest groups such as PLHA.

Disclosure by PLHA of their sero-status is vital in the quest for active involvement in governance. It was revealed that whereas PLHA are entitled to be members of Ward and Village Multi-sectoral AIDS committees ( PLHA; a male and female), they are not selected principally because they have not come forward to disclose their HIV+ status and be selected on the basis of affirmative action. PLHA therefore face a paradoxical situation; they need positions on community development committees but do not want to disclose their status for fear of being stigmatized, yet the basis for selection as a representative for PLHA is to disclose ones’ sero status. According to community leaders from Biharamulo town Ward, PLHA who have some symptoms interpreted as those of AIDS, cannot be elected to leadership positions because people think that they will die soon.


3.3.3 National level discrimination and marginalization
This is at macro level and is manifested in discriminative policies and laws, and marginalization at the level of resource allocation for example percentage of resources devoted to care and support of PLHA. This study did not investigate the level of resource allocation for care and support of PLHA, but the general view was that this particular aspect is largely provided for in foreign/donor funding.
3.3.4. Policy and legal context.
HIV/AIDS related stigma and discrimination in society is commonly manifested in form of laws, policies and administrative procedure, which are often justified as necessary to protect the general population.
3.3.5. Institution context
3.3.5.1.Education and school, Children with HIV/AIDS or associated with HIV through injected family members have been stigmatized and discriminated against in educational settings in many countries Tanzania being among them. Stigma has led to teasing by classmates of HIV-positive school children or children associated with HIV. Discrimination against HIV positive children in Biharamulo district including from collective activities or expulsion from school, which need legislation which will protect them. However, less concern has been shown far young people who are perceived to be responsible for the HIV infection and who are already stigmatized and discriminated against, because they are sexually active, homosexual or drug users.
3.3.5.2. Employment and the work place. Such discrimination practices include denial of employment to individuals who test positive, termination of employment to PLHA, and stigmatized PLHA who are open about their serostatus. There are some situations where the workers refused to work next to those with HIV/AIDS or those perceived to be PLHA. Scheme providing medical assistance and pensions to employees have come under increasing pressure in countries seriously affected with HIV/AIDS including Tanzania, and some companies have used this reason to deny employment to PLHA. Few companies have developed strategies to combat stigma and discrimination or defined their responsibilities toward employees with HIV/AIDS.
3.3.5.3Health care system this research study revealed that health care settings that is lack of confidentiality and denial of treatment and care is rampant in Tanzania hospitals. Failure to protect confidentiality by clearly identifying patients with HIV/AIDS, revealing serostatus to relatives without prior consent, or releasing information to the media or police appear to be problems in some health services. Factor contributed to this stigma and discriminatory responses including lack of knowledge, moral attitudes and perceptions that for PLHA is pointless because HIV/AIDS is incurable.
3.3.5.4. HIV/AIDS programs, policies and programs may inadvertently contribute to stigmatization and discrimination by differentiating between the general populations and high risk populations’ priotizing actions to prevent HIVspreadind to the former to the later. This approach is after justified in terms of avoiding stigmatization of high risk populations, since targeting such populations is believed to reinforce the association of HIV/AIDS with marginalized group.
However, focusing on programs for the general populations may also reinforce the perceptions that it is les important to protect populations that practice high risk behaviors than the innocent and unsuspecting general population. It may also result in discrimination against marginalized groups, since those at greatest risk do not received the resources they need.
Furthermore, in some settings, allocating resources on the basis of acceptability rather than of need may be a deliberate policy, because of racism, homophobia, or negative attitudes towards marginalized group.
Religion institution, this study come into findings that in some context HIV/AIDS related stigma and discrimination has been reinforced by religious leaders and organizations, which have used their power to maintain the status quo rather than to challenge negative attitudes towards marginalized groups and PLHA. For example at the International symposium Religious Health Organizations Break the Silence on HIV/AIDS, organized by the African Religion Forum of Religious Health Organizations during the 13th International AIDS Conference in July 2000, it was noted that religious doctrine, moral and ethical positions regarding sexual behaviors, sexism and homophobia, and denial of the realities of HIV/AIDS have helped create the perception that those infected have signed and deserved their punishment increasing the stigma and discrimination associated with HIV/AIDS.
3.3.6. Gender Defined marginalization and discrimination of PLHA

Study findings reveal that stigma and discrimination are more pronounced among women, a fact attributed to the willingness of females to disclose their sero-status than their counter-part, the men. Males’ response to a society full of stigma and discrimination differentiates them from most females living with HIV/AIDS and obscures the number of males. While women disclose their HIV+ status to ensure a source of livelihood and to depend on peer support as a coping strategy, the majority of men decide to conceal their status with some secretly going for VCT and registering for ARVs in order to protect their sources of income/jobs.



CHAPTER FOUR
POLICY AND LEGAL ENVIRONMENT ON HIV/AIDS RELATED STIGMA AND DISCRIMINATION.
4.1. Introduction
One of the intended outcomes of the research is enhanced social acceptance of PLHA and community cohesion based on the understanding and respect of the fundamental human rights of the infected and affected. This Section therefore provides an overview of policy environment and legal framework surrounding HIV and AIDS related stigma and discrimination, and presents a review of national policies and laws that directly or indirectly impact on the rights of PLHA.
4.2. National Policies and Laws on HIV/AIDS Stigma and Discrimination
In general, the Country’s Constitution provides for protection of rights for PLHA. But in specific terms, there appears not to be any legislation that directly targets PLHA rights. It has to be noted here that Tanzania was part of the nations that issued a Declaration of Commitment of the United Nations General Assembly Special Session on AIDS (UNGASS) that carry clauses some of which directly promote and protect PLHA rights. Other than laws, there are policies that guide development in the country and which can potentially fuel or arrest HIV/AIDS related discrimination. The following review highlights the strengths and limitations of policies and laws in as far as they protect the rights of those infected and affected by HIV/AIDS.



4.2.1 The Community Development Policy The main import of the Community Development Policy (1996) is to place the ordinary member of the community (and the family as the smallest unit of the community) at the centre of development. The Policy provides for full participation of community members in development activities. One of the areas of its focus is “responding to and meeting the needs of special groups of women, children and youth, in order to reduce their workload, strengthen family income generating projects and enable them to participate in decisions and ownership of family property”. By implication and inference, it is possible that the Community Development Policy addresses albeit marginally, the concerns of persons infected and affected by HIV and AIDS.

It is worth citing that there is no mention of HIV and AIDS anywhere in the Policy document, since AIDS is a recognized development issue. It is understandable that whereas HIV/AIDS was already reported in Tanzania at the time of drafting the Policy, the Tanzanian Government had not yet evolved a solid response to HIV and AIDS as is the case today . To retain its relevancy to today’s development concerns, the Policy needs to be revised to incorporate HIV/AIDS, which will ensure that PLHA right to actively participate in development is restored and protected.

4.2.2 The Constitution of the United Republic of Tanzania (1997)
Part III of the Constitution of the United Republic of Tanzania, (1997) provides in articles 12-24, basic rights of every citizen. The Constitution makes a general pronouncement on any form of discrimination in 12 (2) which state that “no law enacted by any authority in the United Republic shall make any provision that is discriminatory either of itself or in its effect”. Again in 12 (4) “No person shall be discriminated against by any person or any authority acting under any law or in the discharge of the functions or business of any state office”. Discrimination is explained in Article 13 (5) as a means to satisfy the needs, rights or other requirements of different persons on the basis of their nationality, tribe, place of origin, political opinion, color, religion or station in life such that certain categories of people are regarded as weak or inferior and are subjected to restrictions or conditions whereas persons of other categories are treated differently or are accorded opportunities or advantage outside the specified conditions or the prescribed necessary qualifications.” Notwithstanding Article 12(2), in absence of a reference to ‘condition of health’, the word “station in life” which is contained in the above definition may also refer to the condition of being a PLHA. The Constitution further provides for equality before the law in Article 13, the right to life in 14, individual freedom in 15 and privacy in 16. Lastly the Constitution provides for freedom of movement in Article 17 and in 18 to 19, freedom of expression and thought while Articles 22 to 24 provide for the right to work. It clear therefore that the Constitution carries general clauses that can be applied in the protection of the rights of PLHA.

However, as it is the case in most developing countries, people’s awareness and knowledge of the policy and legal frameworks are quite limited to the extent that even parties that are aggrieved cannot easily seek redress. This is further exacerbated by the prevalence of the deprivation trap that most communities find themselves in—poverty, isolation, powerlessness, vulnerability etc.


4.2.3 The National Policy on HIV/AIDS
The overall goal of the policy is to provide a framework of leadership and coordination of the national multi-sectoral response to the HIV/AIDS epidemic. The Policy in clear terms recognizes that stigma is one of the challenges in the prevention and control of HIV and AIDS in the country. The Policy puts the responsibility of fighting stigma largely on health workers, political and government leaders, religious leaders, NGOs, PLHA, community leaders and families. According to the Policy, the first step of fighting stigma is to break the “deadly silence” on HIV and AIDS by all sectors at all levels. The policy furthers sets fighting stigma as one of its 17 Guiding Principles.

In its third specific objective-“Care for PLHAs”, the Policy provides for combating stigma and strengthening living positively (pg10). The policy also provides for protection of PLHA against rights abuse and discrimination. The Policy provides for the following human rights of PLHA:

The right to non-discrimination, equal protection and equality before the law
The right to seek and enjoy asylum
The right to liberty and security of person
The right to highest attainable standard of physical and mental health
The right to privacy
The right to freedom of association
The right to freedom of opinion and expression and the right to freely receive and impart information
The right to marry and to found a family
The right to work
The right to equal access to education
The right to and adequate standard of living
The right to social security assistance and welfare
The right to share in scientific advancement and its benefits
The right to be free from torture and cruel, inhuman or degrading treatment or punishment

In light of developments after its inception, the Policy needs revision to reflect recent changes in the prevention and control of HIV and AIDS. For instance, the policy alludes to PLHA meeting the cost of ARVs, yet they are now provided free by the government. Revision of this clause will provide ammunition for advocacy for increased access of PLHA to medical care mainly ARVs.

Under the mitigation of the impact of HIV and AIDS, the Policy provides for care and support for orphans. However, the definition of the orphan as contained in the Policy marginalizes the majority of children orphaned by AIDS. According to the Policy, an orphan is a child between the ages of 0 to 15 years who has lost both parents (pg 30). This leaves children with one parent out of the care and support provided by government, yet children who have lost their fathers only account for the biggest proportion of all orphans, if we adopt the definition of an orphan as a child who has lost one or both parents. In 2000, only 1.1 percent of children were without both parents compared to 6.4 percent that had no fathers (meaning that they would most likely be under the care of their mothers) and 3.5 percent that were without mothers. In any case, the biggest burden of care for paternal orphans (those without fathers) falls on women, yet women suffer more from HIV and AIDS. At BDH, it was revealed that one out of ten pregnant women who are tested for HIV, are positive. It has also been shown that women suffer more from stigma and discrimination. By leaving out paternal orphans in its care and support bracket, the Policy legalizes their marginalization and compounds the burden of widows especially those living with AIDS.

4.2.4 The National Multi-Sectoral Strategic Framework on HIV/AIDS 2003-2007 (NMSSF)
The NMSSF operationalizes the National HIV/AIDS Policy (2001). As Tanzania is a signatory to the Millennium Development Goals (MDGs) of 2000 and participated in issuing the UNGASS Declaration of commitment, the NMSSF is in line with the two international commitments to development and management of HIV/AIDS respectively.

In its third and fourth thematic areas, the NMSSF provides for care and support and mitigation of the social and economic impact of HIV and AIDS. The NMSSF considers stigma and discrimination as some of the cross-cutting AIDS issues. The policy framework recognizes that the fight against HIV/AIDS is an integral part of the efforts aimed at eradicating poverty. Such commitment at policy level ensures that participation of PLHA in development is guaranteed. Provisions for the mitigation of the economic impact also ensure that PLHA have a guaranteed means of livelihood and that their right to continued employment (as long as is possible) is also guaranteed.
4.3 Awareness of National Policies and Laws on Stigma and Discrimination
Lack of adequate awareness of the national policies and laws on HIV/AIDS related stigma and discrimination is one of the weaknesses of these polices and propagates marginalization of PLHA. There was little evidence of deliberate efforts on the part of government to popularize polices and laws that spell out PLHA rights. In Biharamulo, study participants mentioned Nyarubungo, AMREF and ACORD as organizations that have organized seminars and workshops to raise awareness of PLHA rights. No mention was however made of specific national polices and laws that these organization had targeted to popularize.

In Biharamulo district, the awareness of policies and laws on PLHA rights is much lower than that of other areas, with only a few participants having ever seen the policy documents and being able to mention some of the PLHA rights. ACORD’s sensitization workshops were giving basic information on stigma and discrimination of PLHA.
4.4 Enforcement of Policies and Laws on Stigma and Discrimination
It is difficult if not impossible to enforce rights and laws that one is hardly aware of and among a population with little awareness and knowledge of the laws supposed to be enforced. Ideally before enforcement, there should be awareness raising and public education of the rights of PLHA.

Available literature suggests that a rights-respecting climate encourages voluntary testing, counseling, education, treatment and disclosure about HIV, all measures necessary to stop the epidemic. Repressive measures, on the other hand, stigmatize people with HIV and populations at high risk and perpetuate discrimination against them. The failure to protect the human rights of people infected with HIV encourages secrecy about HIV, driving high-risk populations underground, away from education, testing and counseling services, where HIV will be unknowingly spread, (MacNaughton, 2004).





















CHAPTER FIVE

Research findings and analysis
5.1 The findings
The discussion here reflects the research study and remarks regarding the findings on the human rights and HIV/AIDS related stigma and discrimination against people living with HIV/AIDS in Tanzania.
The findings discussed are based on the interviews conducted between the researcher and the various officers who are stakeholders of human rights in Tanzania, the community at large and individual who are HIV/AIDS positively, non-governmental organizations. Also the findings is based on literature review, which has been conducted through different books and other papers on human rights and HIV/AIDS related stigma and discrimination against people living with HIV/AIDS in Tanzania.
Through different institutions the research tries to reveal different aspect on different institution concerning human rights and HIV/AIDS related stigma and discrimination against people living with HIV/AIDS in Tanzania.
Health care, findings indicate that many cases of discrimination have occurred in the health sector. However, despite this many interviewees still had faith in the public health care system. They believed that the services in IDH and ward of the general hospital were good and that they were treated well. A few agreed that free health care provided by the government hospital gave people who could not afford private health care access to treatment they would otherwise be denied. On the other hand there are much consensus that awareness among health staff, in public and private must be addressed. They brought up several instances where health staff including doctors, nurses, attendants, and minor staff had discriminated against PLHA and their families.
Breach of confidentiality, according to the interviewee there are several case in which confidentiality regarding a patients of HIV/AIDS status was not respected. A few interviewees mentioned that they had lost their job as a result of their status being made known to the public. In one case, a lab had been shocked by a result, for it been the first time he had seen a test come back positive for HIV. He had shared the information with his colleagues at the lab and the rest of hospital. In the case of the patient who had since passed away due to complications resulting from ADIS, the interviewee was diagnosed with HIV at the public hospital. A person working in the hospital had found out his HIV status and spread the information around their village. This resulted into stigmatization and discrimination of both the patient and family by member of community. Another case which implicates the confidentiality issue occurred at a private hospital. The patient had been tested there since his brother in law was employed by the hospital. Where the test result turned positive, prior to informing the patient, the doctor passed the result on to the patient’s brother in law. Furthermore the test results had been leaked by the hospital lab, and as a result the entire hospital staff learnt about it. The patient stated that the immediate family was only notified after everyone in the hospital had already found out. People outside he hospital, such as van driver parked near the hospital, were told of the case. One such van driver was from the same village as the patient and spread the news of the patient HIV status through out the village. This led to various acts of discrimination, people wanted them to leave the village making derogatory comments and informing the child schools which in turn led to complications at school.
Unprofessional treatment by health staff. Health staff should be educated on and sensitized toward HIV/AIDS. So that will be able to take proper preparations and treat the patients in a non discriminatory manner. The majority who are interviewed stated that they sought counseling after findings out hat they were HIV positive. This generally has a positive impact in helping people cope with their HIV/AIDS status and provided support for their families.
Lack of basic services. This can be seen as a result of a story provided by one relative of the patient, who was HIV positive,
On admission we found that the patient is left alone in the rooms without any
assistance to arrange their belongings in the bedside cupboards. These cupboard are very dirty are discared empty plastic battles, bags and a conglomeration of
rubbish. We set about cleaning them out, arranging the beds, then discover no
pillow are provided as they burn these after the departure of each patient
expect the families to provide this as well as the covering sheet. Also no
plates, cups and cuttery are given and we were very helpfully advised to buy
everything in plastic to avoid breakage! Though we were told that they should
call for help there are no call bells so how do these people who are quite weak
should till they are heard? the youth was very weak and he said that unless his
mother is there no one bothers about him. This was confirmed when one day
I visited at a noon and though he was hungry no lunch was provided, and the
Nurse said that because his mother normally brings lunch for him at about 2 pm
they did not give anything to eat. This meant that he was left hungry for about
two hours till his mother arrived with the meal. Supposing she got delayed or did
not turn up he would have been left without food.
Education: according to the interview conducted, there were few cases where discrimination took place in the area of education. In two situations where such discrimination had taken place, it was by parents of other students and not by the institution itself. In one case, parents of other student had found out that the mother of a student was HIV positive. They had requested that, that child be removed from the school. In other case a few parents had removed their children from a primary school on account of the presence of a child whose father had died of AIDS and whose mother was HIV positive. The teacher however had stood by child and refused to discriminate against him.
Employment: the majority of the people interviewed during the study were unemployed, and a few were self employed several cases involving discrimination in the workplace were highlighted. In these cases the PLHA had to leave employment
Loss of employment, interviewee narrated severe instances where he had been asked to leave his job as a result of HIV status. He had started working as a restaurant with his cousin when someone leaked his status to his cousin his cousin had then requested he quit. The cousin concern was that no one would come to the restaurant if they knew that there was a HIV positive person working there. The interviewee second job was at a flower shop but after six months the owner had heard about his status and forced him to leave. In this situation the owner had not even allowed the interviewee to come by the shop to collect his pay cheque but had insisted on posting it.
Family level: many of the interviewee felt shock at the first finding out that they were HIV positive. They questioned why and how they had contracted the disease, many times asked why me? What did I do to deserve this? And why am I getting it at this time when I have a good job and loving family? They also wonder how they would be able to face their family friend, colleagues and society in general. However in this aspect there are two perspectives. There are positive aspects in which the majority interviewee has only shared knowledge of the HIV/AIDS with their close family, spouses, children, parents or friends. It is only in a few cases that they have revealed it to others. The majority stated that they received emotional and psychological support from their families and friends, some even received financial support.
On the other hand there are negative aspect at this family level, the majority could not recall incidents in which they or their families were threatened, assaulted, harassed, or ridiculed as a result of HIV/AIDS. There was one situation however HIV positive status was known to most in the village, having been leaked by health worker in the hospital. Her husband’s brother had wanted her and her family to leave the village, as they were feared that people in the village would be affected by the illness.

Housing: majority interviewed during the research study lived in their own home thus had not experience any discrimination as far as housing was concern. However on the other hand children who had been left without parents are the one who got problems in housing.

Social life: due to ignorance and fear, PLHA and their families are often treated with insensitivity and cruelty. Lack of awareness on what HIV/AIDS is and how it can be transmitted has left many people with misconceptions about the disease. Fear and ignorance can lead to various discriminatory practices with sometimes turn violate.
During my research I come to across several organizations conducting programmes to raise awareness and educate people about HIV/AIDS. While it is encouraging that these programmes are taking place, they often lack any follow up. Programmes and projects are implemented for a short duration, which is after insufficient to adequately promote awareness. Therefore it is unlikely that levels of stigma and discrimination will decrease as effective programmes have yet to reach the people. There needs to be more long term planning, with target groups identified and awareness rising and education programmes conducted in a systematic consistence manner. It is also suggested that there be move work done at the grassroots level.












CHAPTER SIX
CONCLUTION AND RECOMMENDATIONS
6.0 Introduction
This chapter summarizes this whole research paper in respect of what is indicated and explained in the previous chapters. It sums and recommend to approaches and strategies that can be adopted and utilized in order to ensure respective and qualified standards of laws governing human rights and HIV/AIDS related stigma and discriminations against people living with HIV/AIDS of which can be put into effect and comply with international human rights norms and standards, thus ensure total effectiveness of these laws.


6. 1 Conclusion
The aim of the research study was to look on the human rights and HIV/AIDS related stigma and discrimination in Tanzania, awareness of HIV/AIDS stigma and discrimination in Tanzania, analyzing stigma and discrimination among the PLHA, and reviewing policy and legal environment on HIV/AIDS related stigma and discrimination against people living with HIV/AIDS.


The research study revealed that the problem of stigma and discrimination against people living with HIV/AIDS as the violation of human rights exist and that, it is increasing everyday especially within rural areas in Tanzania.

The evidence thereof shows that Tanzania is now more serious about stigma and discrimination against people living with HIV/AIDS whereby people mostly affected by this problem are the orphans and women in rural areas within United Republic of Tanzania. Lack of awareness on human rights knowledge in rural areas within Tanzania against people living with HIV/AIDS contribute to this, the language used in the legislation which aimed to promote and protect the rights of people living with HIV/AIDS is not satisfactory to its aimed, cultural believes among others.

The research study has also found that the laws and policy in Tanzania governing human rights against people living with HIV/AIDS currently are not effective and they are below the standard compared to international standards as explained in the United Nations Protocol, and the Universal Declaration of Human Rights.

Even though there have been solutions governing the problem of human rights and HIV/AIDS related stigma and discrimination against people living with HIV/AIDS in Tanzania, but still there are legal problems and gaps therein which at the moment are scattered through various statutes. Hence, there comes a great need of reviewing the legislation so that those problems are cured and the gaps are filed.

Moreover, HIV/AIDS is a global predicament; therefore, there is a lack of global systematic research that can lead to reliable data on the violation of human rights against people living with HIV/AIDS. If this is performed, it would allow comparative analysis and the design of counter measures against the same. In this regard, there is a need of Tanzania government to co-ordinate with all the international initiatives in combating human rights and HIV/AIDS related stigma and discrimination against people living with HIV/AIDS.


The lawyers, the role becomes even greater. This is to say, besides putting the law in motion for combating violation of human rights against people living with HIV/AIDS, through legal assistance, investigation, litigation and prosecuting the violator of human rights, the advocate also have a role of advocating for charge including but not limited to information dissemination for public awareness, law reform and advocating for the realization of social-economic rights, the lack of which is the grinding stone to causes of human rights violations against people living with HIV/AIDS.


6.2. Recommendations:
Tackling HIV related stigma, discrimination and human rights violation is critical in slowing the impact of the epidemic. Stigma and discrimination impact negatively on every aspect of the prevention-care treatment continuum, as well as greatly increasing the suffering associated with living with HIV.
Stigma, discrimination and human rights violations are intimately, reinforcing and legitimizing each other. Multifaceted action, sustained overtime is needed to prevent stigma, challenge discrimination when it occurs in specific settings, and promote and protect HIV-related human rights.

Anti discrimination laws, policies, and codes of professional ethics will remain ineffective or in other word in order to have comprehensive and effective anti discrimination and stigma legislation, policies, and codes the following must be included:
i. Identification, analysis and response to the specific nature of stigma and discrimination in Tanzania.
ii. Creation of a definite comprehensive definition of stigma and discrimination against people living with HIV/AIDS to Tanzania environment.
iii. Prohibition of any kind of stigma and discrimination
iv. Enhancement of investigation tools
v. The legislation should not do away with the protection of rights of vulnerable groups against vulnerability of HIV infection
vi. The legislation should clearly come to cure and open up the way for PLHA when their rights are violated to seek redress easily rather than long way which existing through the Basic Rights and Duties Enforcement Act.
vii. The legislation should provide heavy punishment for people who will violate the rights of PLHA especially stigma and discrimination to amount to constitute death penalty since violation of the rights of PLHA means causing death to them.

Apart from having specific anti discrimination, and stigma, the other comments to put forward here are
• State monitoring and enforcement of human rights in the right of HIV/AIDS. In this aspect state should concentrate on the Constitution of United Republic of Tanzania ; the bill of rights, the Constitution Amendment of 2000 has finally prohibited discrimination on the basis of gender. Although the Basic Rights and Duties Enforcement Act , provides for mechanism whereby aggrieved citizens can invoke the constitution to challenge violation of their basic rights the process is cumbersome and inevasible for most Tanzania especially women, who form the bulk of the poor, women are also vulnerable group of HIV infection. In the other hand Basic Rights and Duties Enforcement Act especially section 10 and section 13 need to be reassessed in the right of HIV/AIDS so the act is useful in addressing infringement of human rights. The requirement of three judges to convene a constitutional court where there is acute shortage of judges causes’ inordinate delay.
• Codification of international human rights instrument in domestic law. Example of these international instrument are Universal Declaration of Human rights , International Covenant on Civil and Political Rights(CCPR) in which under article 2 of the Covenant prohibit discrimination of any kind such as race, colour, sex, language, religion, political or other opinion .On the other hand International Covenant on Economic, Social, and Cultural Rights(ICESCR) provide under article 2(2) prohibit the same. Both of these Covenant Tanzania has not yet ratified it despite of being ratified by 144 countries all over the world.
• There must be protection of rights of PLHA with special focus on prevention of stigmatization and discrimination.
• Protection of rights of women and children and other vulnerable groups against vulnerability to HIV infection include care and orphan.
















REFERENCE:
International Instruments
• The International Covenant on Civil and Political Rights 1966
• The International Covenant on Economic, Social, and Cultural Rights 1966
• The Universal Declaration of Human Rights 1948.

Local statutes.
• The Constitutional of United Republic of Tanzania of 1977 as amended Time to Time
• Tanzania Government of, Basic Rights and Duties Enforcement Act 1994.
• Tanzania Government of, The Constitution(fifth) Amendment Act No.11 of 1984

Articles
• Grimm, N. ‘Combating Discrimination Against AIDS Patients in Tanzania’ (2003)
• Miriam, M. ‘Africa Legal Aid’ Jan-March 2001.




Papers
• Mukoyogo, M.C. ‘Ethics, Law, Human Rights and HIV/AIDS Precention and Control in Tanzania’ Paper presented to the University of Dar Es Salaam AIDS Technical Committee, 27 July 2001.
• McNaughton, G. ‘Women’s Human Rights Related to Health-Care Services in the Context of HIV/AIDS’ Health and Human Rights Working Paper Series No.5 WHO

Websites
• http://www .kituochakatiba.co.ug/Tanzania Constitution
• http:// www.archives.healthdev.net/af-aids
• http:// www.cdc.gov/nchstp/od/hiv-plan
• http:// www.unaids.org/whatsnew/speech/eng/piot040901/racism.htm
• http://www.popcouncil.org/horizon
• http:// www.usaids.gov
• http:// www.tanzania.go.tz
• http://www.who.un.co

Others