With the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Bill being approved, there is hope for those who face stigma and discrimination
By Dinesh C Sharma
Three decades after the first HIV case surfaced in India, the country is ready with a legal framework to end the discrimination and stigma linked with the disease. The AIDS Bill has been a subject of deliberation outside and inside parliament for over a decade now. And in October 2016, the cabinet finally approved a new version of the Human Immunodeficiency Virus and Acquired Immune Deficiency Syndrome (Prevention and Control) Bill which was originally introduced in the Rajya Sabha on February 11, 2014.
The objective of the proposed legislation is to prevent and control HIV and AIDS, and prohibit discrimination. It will provide for informed consent and confidentiality with regard to treatment and will make it obligatory for establishments to safeguard the rights of HIV positive workers. The draft Bill seeks to create mechanisms for redressing complaints relating to stigma and discrimination.
From the beginning, HIV-positive people have had to face stigma and discrimination due to misconceptions associated with the illness. As it is, the disease affected marginalized communities such as sex workers and injectable drug users. On top of it, they have had to face discrimination from all quarters. There have been instances of such people being thrown out of their jobs, being denied access to healthcare and employment and their children being forced to leave schools.
Over the years, interventions were designed and implemented to sensitize people, communities and employers. This brought about some change but the discrimination continued. In 2015, a survey conducted by the National Integrated Biological and Behavioral Surveillance among key populations showed that 27 percent of female sex workers, 17 percent men who have sex with men and 46 percent of injectable drug users reported disrespectful treatment by family, friends and neighbors due to their HIV-related risk behavior.
The objective of the proposed Bill is to prevent and control HIV and AIDS, and prohibit discrimination. It will provide for informed consent and confidentiality with regard to treatment and will make it obligatory for establishments to safeguard the rights of HIV positive workers. The draft Bill seeks to create mechanisms for redressing complaints relating to stigma and discrimination.
But there has been a reduction in the overall number of cases of stigma and discrimination reported. Successful interventions in reducing deaths as well as providing free treatment for HIV-positive people, has seen the affected live longer and relatively healthier lives. India currently has over 2.1 million people with HIV and some 86,000 new infections are reported every year.
Under the United Nations, a paradigm shift has been recommended in the Sustainable Development Goals. The world is now talking about ending AIDS by 2030, instead of just trying to control it. In order to do so, AIDS response has to be fast-tracked in the next five years. Targets are set for 2020 wherein countries have to reduce new infections, achieve targets with respect to detection of HIV-positives and their retention on Antiretroviral Therapy (ART) and viral suppression. All global declarations have recognized elimination of discrimination as a key target to be achieved by all countries. The 2016 Political Declaration on HIV, adopted by the UN, calls on the world to eliminate HIV-related stigma and discrimination by 2020.
In 2015, the National AIDS Control Organization established a Technical Resource Group on Stigma and Discrimination to develop a national framework to address HIV-related issues. State Grievance Redressal Committees have been set up to protect the interests and rights of HIV-positive people and to ensure that stigma-free services are provided to People Living with HIV and other marginalized communities.
The new Bill will provide legal teeth to such efforts, as it incorporates penalties, including a maximum of two-year jail term for discriminatory practices against HIV-positive people. The Bill makes denial, termination, discontinuation or unfair treatment with regard to employment, educational establishments, healthcare services, residing or renting property a punishable offense. It also seeks to prohibit HIV testing as a prerequisite for obtaining employment or accessing healthcare or education. Establishments with 100 employees or more will have to appoint a complaint officer to look into the grievances of those with HIV and AIDS. The draft says that “no person shall be compelled to disclose his HIV status except with his informed consent, and if required by a court order.”
However, the Bill does not guarantee universal treatment and care. “The Bill makes it mandatory for states and the central government to provide ART as far as possible for patients,” said health minister JP Nadda. The words “as far as possible” show lack of full commitment on the part of the government to provide treatment for all. The Bill has a provision for the appointment of an ombudsman by state governments to inquire into complaints related to the violation of the Act and penal actions in case of non-compliance. On this aspect also, the government feels that “the ombudsman need not be a separate entity, but any existing state government functionary can be deputed or given additional charge”.
The Bill also seeks to prohibit HIV testing as a prerequisite for obtaining employment or accessing healthcare or education. Establishments with 100 employees or more will have to appoint a complaint officer to look into the grievances of those with HIV and AIDS. The draft says that “no person shall be compelled to disclose his HIV status except with his informed consent, and if required by a court order.”
Reactions to the Bill were varied. Manoj Pardesi of the National Coalition of People Living with HIV, said: “We have been demanding the passing of this Bill for the last 10 years. I hope now there is no delay and the Bill is passed in the winter session.”
Anand Grover, project director of Lawyers Collective, said: “Many countries like Vietnam and Kenya have passed their HIV laws years ago. It’s time that India doesn’t delay this anymore and ensures that the Bill is passed now.”
Dr Ishwar Gilada, President, AIDS Society of India, said that scientific evidence has proven that effective strategies to prevent, diagnose, treat and care for HIV are there, making it theoretically a chronic manageable disease. “But a reality check will tell us a grim tale of AIDS prevention and control in India: we are surely not doing all we can and we should, with full thrust to prevent, test and treat HIV, despite available knowledge and resources at our disposal.”
Paul Lhungdim, Delhi Network of Positive People, was apprehensive about the full import of the Bill. “Free and complete treatment is the core of the Bill for us. We hope the Bill which is cleared by the cabinet is providing it,” he said.
While the Bill meets a long-standing demand of people living with HIV and health activists, it is still a long way before discrimination and stigma can actually end.
Lead pictures: (L-R) Union Minister for Health and Family Welfare JP Nadda along with the President of Kenya, Uhuru Kenyatta, at a high-level meeting on health for “Ensuring access to lifesaving medicines to end the AIDS epidemic by 2030”, on the sidelines of the India-Africa Forum Summit (Photo: PIB); Doctors examine an AIDS patient in hospital (Photo: msfindia.in)